Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ellice Clark

Individual provider Registered Nurse · NPI 1679287395

Ellice Clark is a Certified Registered Nurse Anesthetist (CRNA) in Detroit, Michigan. Qualified in 2024, 2 years ago. Practices with Northstar Anesthesia of Michigan III PLLC, a 567-clinician group. Licensed in Michigan.

Years since qualifying
2
Licensed in
MI
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

4001 W McNichols Rd
Detroit, MI 48221-3038
Phone: (313) 993-1245
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 4704345479 (MI)
Registered Nurse Taxonomy 163W00000X · Licence 4704345479 (MI)

Record details

NPI number1679287395
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 9, 2023
Last updated in NPPESNovember 21, 2024
Certification dateNovember 21, 2024
Mailing address13032 Woodridge Cir, Plymouth, MI 48170-3892

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Northstar Anesthesia Of Michigan Iii Pllc — 567 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Detroit