Provider Demographics
NPI:1801970231
Name:CLARK, BARBARA ELLEN (APN-C)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ELLEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3949
Mailing Address - Country:US
Mailing Address - Phone:609-689-9523
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:107 EICKHOFF HALL
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1104
Practice Address - Country:US
Practice Address - Phone:609-771-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09296900163WC1400X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS63886Medicare UPIN