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NPI Code Detail

MEDICARE: JANELISE S CLARKE NP

MEDICARE: JANELISE S CLARKE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerNP661AID
2363LP0200XPediatric Nurse PractitionerNUR-APRN-LIC-125338MT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00393459OTHERIDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010160650OTHERIDREGENCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3300936OTHERIDALTIUS HEALTH PLANS

General Provider Information

NPI Number : 1275602633
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELISE S CLARKE NP
Provider Business Mailing Address
First Line : 15333 N PIMA RD STE 312
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85260-2783
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 14355 MIRANDA WAY
Second Line :
City : LOS ALTOS HILLS
State : CA
Zip : 94022-2032
Country : US
Telephone Number : 650-546-7775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 05/18/2026

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