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General NPI Number Information
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NPI Number | 1518889591
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Entity Type | Individual
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Provider Name | MARY KATHRYN CLARK DNP, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 1950 N HARLEM AVE
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-3717
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Country | US
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Telephone | 708-453-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 9217 MARMORA AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-1509
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209036201
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License Number State | IL
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