Healthcare Provider Details

I. General information

NPI: 1518889591
Provider Name (Legal Business Name): MARY KATHRYN CLARK DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N HARLEM AVE
ELMWOOD PARK IL
60707-3717
US

IV. Provider business mailing address

9217 MARMORA AVE
MORTON GROVE IL
60053-1509
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036201
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: