Individual
MARY ELLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
824 HUNTINGTON AVE, WARREN, IN 46792-9277
(260) 375-2965
(260) 375-2969
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
201250210NP
OR
363LF0000X
Family Nurse Practitioner
Primary
71016668A
IN
363LF0000X
Family Nurse Practitioner
CNP-02460
NM
363LP2300X
Primary Care Nurse Practitioner
66049
ID
Other
Enumeration date
12/26/2012
Last updated
10/07/2025
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