Clark, Lisa M
Clark, Lisa M is an individual health care provider with primary practice located at University Hosp Medical Center Stony Brk Dept Pediatrics Hsc 11Th Floor, Stony Brook NY 11794-0001. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Clark, Lisa M can be contacted via phone (631) 444-2967.Contact Information
Primary practice address
University Hosp Medical Center Stony Brk Dept Pediatrics Hsc 11Th Floor
Stony Brook NY 11794-0001
Phone: (631) 444-2967
Fax: (631) 444-6212
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 380567 | New York |
Profile Details
| NPI number | 1710146220 |
|---|---|
| LBN Legal business name | Clark, Lisa M |
| Credentials | CPNP-AC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2008 |
| Last updated | Jun 9th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710146220 | NPPES |
| New York | Other | 380567 | NYS LICIENCE NUMBER |
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