Illise Clark, FNP-NP
Nurse Practitioner, Family in Mentor, OH. Individual provider (NPI-1).
NPI number1396004776
StatusActive
Last updated in NPPESMay 12, 2026
Details
- NPI
- 1396004776
- Entity type
- Individual (NPI-1)
- Name
- Illise Clark
- Credential
- FNP-NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 7, 2012
- Certification date
- May 12, 2026
- Last updated
- May 12, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | APRN.CNP.0022454 | OH | Yes |
| 163W00000X | Registered Nurse | RN.371331 | OH |
Practice location
8881 Schaeffer StMentor, OH 44060-5035
Phone 440-255-9309
Mailing address
8881 Schaeffer StMentor, OH 44060-5035
Phone 440-255-9309
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