Individual
MARYANNE C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2715 N 3RD ST, PHOENIX, AZ 85004-1106
(602) 264-4331
Mailing address
202 E EARLL DR STE 200, PHOENIX, AZ 85012-2647
(602) 865-0008
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP11153
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP11154
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376867
—
AZ
Enumeration date
11/08/2005
Last updated
02/19/2019
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