Provider Demographics
NPI:1396137592
Name:CLARK, ERIN ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 JONES MILLS STAHLSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:STAHLSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15687-1235
Mailing Address - Country:US
Mailing Address - Phone:724-396-5740
Mailing Address - Fax:
Practice Address - Street 1:5706 GLADES PIKE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-8302
Practice Address - Country:US
Practice Address - Phone:814-444-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily