Individual
CHALISE L LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5501 OLD YORK RD, TOWER 3, PHILADELPHIA, PA 19141-3018
(215) 456-6850
(215) 456-8539
Mailing address
101 E OLNEY AVE, STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-7000
(215) 254-2599
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN539928
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083525
NBCRNA
PA
Enumeration date
01/16/2010
Last updated
07/31/2019
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