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General NPI Number Information
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NPI Number | 1275602633
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Entity Type | Individual
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Provider Name | JANELISE S CLARKE NP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 14355 MIRANDA WAY
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City | LOS ALTOS HILLS
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State | CA
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Zip | 94022-2032
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Country | US
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Telephone | 650-546-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 4254 W ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85226-7246
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Country | US
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Telephone | 888-731-8994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP661A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NUR-APRN-LIC-125338
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License Number State | MT
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