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General NPI Number Information
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NPI Number | 1982985180
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Entity Type | Individual
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Provider Name | ELIZABETH ELLEN CLARKE RN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 8420 W BRYN MAWR AVE SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60631-3479
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Country | US
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Telephone | 773-355-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 306 BUSSE RD
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City | MARENGO
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State | IL
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Zip | 60152-8040
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Country | US
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Telephone | 815-943-0253
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.220408
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License Number State | IL
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