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General NPI Number Information
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NPI Number | 1902457450
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Entity Type | Organization
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Legal Business Name | CLARK, NELSON, AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2600 S MICHIGAN AVE STE LLD
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-866-4642
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S MICHIGAN AVE STE LLD
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-866-4642
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | SHAMMONA CLARK
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Credential | NP-C
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Telephone | 574-298-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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