MEDICARE: EMMA CLELLAND

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
1	363LF0000X	Family Nurse Practitioner	26NJ14931200	NJ

General Provider Information

NPI Number	:	1437908316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA CLELLAND

Provider Business Mailing Address
First Line	:	179 CEDAR LK E
Second Line	:
City	:	DENVILLE
State	:	NJ
Zip	:	07834-1870
Country	:	US
Telephone Number	:	973-830-0627
Fax Number	:

Provider Business Practice Location Address
First Line	:	7501 SURRATTS RD STE 304
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-3377
Country	:	US
Telephone Number	:	301-868-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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Directions to “ EMMA CLELLAND ” Practice Location

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