Provider Demographics
NPI:1689602468
Name:CLARK, FRANCES (APRN MSN FNP CS)
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN MSN FNP CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 W STATE RD 10
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310
Mailing Address - Country:US
Mailing Address - Phone:219-345-5151
Mailing Address - Fax:219-345-5252
Practice Address - Street 1:11920 W STATE RD 10
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310
Practice Address - Country:US
Practice Address - Phone:219-345-5151
Practice Address - Fax:219-345-5252
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000776A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P10432Medicare UPIN
235510AMedicare ID - Type Unspecified