LISA M CLARK CPNP-AC NPI 1710146220

NPI Information

NPI: 1710146220
Provider Name: LISA M CLARK, CPNP-AC
Classification: Nurse Practitioner - 363LP0200X
Specialization: Pediatrics
Entity Type: Individual
Address: UNIVERSITY HOSP MEDICAL CENTER STONY BRK
DEPT PEDIATRICS HSC 11TH FLOOR
STONY BROOK, NY
ZIP 11794
Phone: (631) 444-2967

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NPI Details

Lisa M Clark, CPNP-AC is a pediatrics nurse practitioner in Stony Brook, NY. Lisa M Clark, CPNP-AC NPI is 1710146220. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

UNIVERSITY HOSP MEDICAL CENTER STONY BRK
DEPT PEDIATRICS HSC 11TH FLOOR
STONY BROOK, NY
ZIP 11794-001
Phone: (631) 444-2967
Fax: (631) 444-6212

The enumeration date for this NPI number is 6/9/2008 and was last updated on 6/9/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	380567	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	380567	OTHER	NEW YORK	NYS LICIENCE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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