Individual
MRS. ELISE DIANE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP BC
Contact information
Practice address
607 ELIDA AVE, DELPHOS, OH 45833-1736
(419) 991-7805
Mailing address
1001 BELLEFONTAINE AVE, LIMA, OH 45804-2800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.06689
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2360252
—
OH
01
—
500023896
TRAVELERS/RAILROAD MEDICA
OH
01
—
9934001
MEDICARE PTAN
OH
Enumeration date
09/13/2005
Last updated
04/29/2026
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