Individual
MS. ALISA L. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
A.I. DUPONT HOSPITAL FOR CHILDREN, 1600 ROCKLAND ROAD, WILMINGTON, DE 19803
(302) 651-4000
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
030126
PA
363L00000X
Nurse Practitioner
Primary
L10024969
DE
363LP0200X
Pediatric Nurse Practitioner
L10024969
DE
363LP0200X
Pediatric Nurse Practitioner
RN308838L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043338
—
NJ
05
—
103045134
—
PA
05
—
4058356
—
MD
Enumeration date
09/28/2006
Last updated
08/09/2018
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