Provider Demographics
NPI:1821569880
Name:CLARK, SARAH BETH (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GODBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 263
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3844
Mailing Address - Country:US
Mailing Address - Phone:312-942-6700
Mailing Address - Fax:312-942-3633
Practice Address - Street 1:1725 W HARRISON ST STE 263
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3844
Practice Address - Country:US
Practice Address - Phone:312-942-6700
Practice Address - Fax:312-942-3633
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021275363LF0000X
MECNP181300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily