Provider Demographics
NPI:1316368848
Name:CLARK, ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1630 E HIGH ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3244
Mailing Address - Country:US
Mailing Address - Phone:610-327-1631
Mailing Address - Fax:610-327-1199
Practice Address - Street 1:1630 E HIGH ST
Practice Address - Street 2:BLDG 4
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3244
Practice Address - Country:US
Practice Address - Phone:610-327-1631
Practice Address - Fax:610-327-1199
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP013560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health