Individual
LISA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
UNIVERSITY HOSP MEDICAL CENTER STONY BRK, DEPT PEDIATRICS HSC 11TH FLOOR, STONY BROOK, NY 11794-0001
(631) 444-2967
(631) 444-6212
Mailing address
UNIVERSITY HOSP MEDICAL CENTER STONY BROOK, DEPT PEDIATRICS HSC 11TH FLOOR, STONY BROOK, NY 11794-8111
(631) 444-2967
(631) 444-6212
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
380567
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
380567
NYS LICIENCE NUMBER
NY
Enumeration date
06/09/2008
Last updated
06/09/2008
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