LISA M CLARK (NPI# 1710146220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710146220 |
| Entity Type | Individual |
| Full Name | LISA M CLARK |
| Credential | CPNP-AC |
| Practice Address |
University Hosp Medical Center Stony Brk Dept Pediatrics Hsc 11th Floor Stony Brook NY 11794-0001 |
| Mailing Address |
University Hosp Medical Center Stony Brook Dept Pediatrics Hsc 11th Floor Stony Brook NY 11794-8111 |
| Practice Telephone | 6314442967 |
| Practice Fax Number | 6314446212 |
| Mailing Telephone | 6314442967 |
| Mailing Fax Number | 6314446212 |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
380567 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | NYS LICIENCE NUMBER | 380567 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154776912 | Lisa Clark | Counselor | 8722 Heaton St, New Orleans, LA 70118-2616 | 2016-04-29 |
| 1548694383 | Lisa G Clark | Speech-Language Pathologist | 2405 Champaign Ave, Mattoon, IL 61938-2646 | 2013-08-28 |
| 1073857801 | Lisa Ann Clark | Specialist | 1110 Chenango St, Binghamton, NY 13901-1668 | 2012-11-16 |
| 1952680324 | Lisa S Clark | Counselor | 1223 Meadow Lake Rd, Rockledge, FL 32955-8403 | 2011-08-16 |
| 1134456445 | Lisa Lynn Clark | Occupational Therapist | 85 Lunt Rd, Brunswick, ME 04011-7289 | 2009-11-06 |
| 1437485836 | Lisa Landers Clark | Counselor | 1 Waterford Ln, Savannah, GA 31411-1305 | 2009-10-20 |
| 1376742841 | Lisa M Clark | Specialist | 4308 N 26th St, Tacoma, WA 98407-5211 | 2007-07-15 |
| 1356453260 | Lisa M Clark | Dentist | Bonham Family Dentistry, 101 E 9th Street, Bonham, TX 75418 | 2006-08-31 |
| 1598779100 | Lisa Bardy Clark | Family Medicine | 12815 Highway 98 West, Suite 116, Destin, FL 32550 | 2006-07-28 |
| 1952378226 | Lisa Clark | Psychologist | 225 Medical Way, Riverdale, GA 30274-2522 | 2006-03-04 |
| Street Address |
UNIVERSITY HOSP MEDICAL CENTER STONY BRK DEPT PEDIATRICS HSC 11TH FLOOR |
| City | STONY BROOK |
| State | NY |
| Zip Code | 11794-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619506714 | Ryan John Kottmeier | Physician Assistant | 101 Nicolls Road Suny Stony Brook Hospital, Dept of Orthopedics Hsc T18, Room 080, Stony Brook, NY 11794 | 2020-04-02 |
| 1699302109 | Michael Trentalange | Student in an Organized Health Care Education/Training Program | Department of Surgery, Health Sciences Center Level 19, Room 030, Stony Brook, NY 11794 | 2020-03-25 |
| 1164985156 | Lauren Kate Harris | Student in an Organized Health Care Education/Training Program | Stony Brook Medicine, Department of Ob/gyn, Hsc T9, 101 Nicolls Road, Stony Brook, NY 11794 | 2019-04-08 |
| 1851851448 | Kathy Tin | Student in an Organized Health Care Education/Training Program | Dept of Medicine Hsc 16 Suny Stony Brook Hospital, Stony Brook, NY 11794 | 2019-03-21 |
| 1174083703 | Arham Khan | Student in an Organized Health Care Education/Training Program | Dept of Medicine Hsc Level 16, Suny Stony Brook Hosp, Stony Brook, NY 11794 | 2019-03-20 |
| 1396221982 | Aman Bhojani | Student in an Organized Health Care Education/Training Program | Suny At Stony Brook Dental School, South Drive, Stony Brook, NY 11794 | 2018-07-17 |
| 1699265629 | Belliny Phaeton | Student in an Organized Health Care Education/Training Program | Stony Brook Children's Hospital, Hsc T-11, Room 040, Stony Brook, NY 11794 | 2018-05-15 |
| 1629568969 | Rachel Herold | Student in an Organized Health Care Education/Training Program | Stony Brook Children's Department of Pediatrics, Hsc T-11, Room 040, Stony Brook, NY 11794 | 2018-05-11 |
| 1598254419 | Nora Ann Diraimondo | Nurse Practitioner | Sb Hospital 101 Nicolls Road, Department of Medicine, Stony Brook, NY 11794 | 2018-05-07 |
| 1386140705 | Ryan Christopher Corn | Student in an Organized Health Care Education/Training Program | Dept. of Internal Medicine, Hsc Level 16-020, Suny Stony Brook, Stony Brook, NY 11794 | 2018-04-04 |
| Find all providers in zip 11794 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164976452 | Chelsea Finn | Nurse Practitioner | 100 Nicolls Rd # 11n, Stony Brook, NY 11794-1423 | 2016-08-04 |
| 1023382660 | Joanne M Camarda | Nurse Practitioner | 101 Nicolls Rd Fl Hsc11, Stony Brook, NY 11794-2911 | 2012-02-29 |
| 1639492143 | Debra Margaret Giugliano | Nurse Practitioner | Department of Pediatrics Tower 11, Room 020, Stony Brook, NY 11794-8111 | 2010-03-11 |
| 1578709119 | Michelle L Ceo | Nurse Practitioner | Hsc T19-068 Nichols Rd., Stony Brook, NY 11794 | 2009-01-04 |
| 1174566079 | Lisa Romard | Nurse Practitioner | Stony Brook Childrens Hospital, T-11, Rm 080, Stony Brook, NY 11794-8111 | 2006-06-14 |
| 1427096742 | Kathleen C Usmani | Nurse Practitioner | 100 Nichols Rd, Stony Brook, NY 11790 | 2006-06-02 |
| 1235128638 | Ann Courtney | Nurse Practitioner | Health Sciences Center T11-080, Stony Brook, NY 11794-0001 | 2005-10-18 |
| 1265994271 | Ashley Jean Mecchella | Nurse Practitioner | 101 Nicolls Rd, Stony Brook, NY 11794-0001 | 2019-04-01 |
| 1750732319 | Dawn Marie Mclaughlin | Nurse Practitioner | 101 Nicolls Rd, Stony Brook, NY 11794-0001 | 2016-06-24 |
| 1437548344 | Susan Katz | Nurse Practitioner | 100 Nicolls Rd, Deptarment of Pediatrics, Stony Brook, NY 11794-8111 | 2015-01-15 |
| Find all providers in STONY BROOK | ||||
| City | STONY BROOK |
| Zip Code | 11794 |
Please comment or provide details below to improve the information on LISA M CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.