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NPI Code Detail

MEDICARE: MS. MAUREEN MCLEAN FNP

MEDICARE: MS. MAUREEN MCLEAN FNP
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
1363LF0000XFamily Nurse Practitioner325122CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113273OTHERNURSE PRACTITIONER CERTIF
213273OTHERCAFURNISHING NUMBER
3325122OTHERCARN LICENSE

General Provider Information

NPI Number : 1508089079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAUREEN MCLEAN FNP
Provider Business Mailing Address
First Line : 750 ELK CREEK RD
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95531-8589
Country : US
Telephone Number : 707-464-6789
Fax Number :
Provider Business Practice Location Address
First Line : 5905 LAKE EARL DR
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95532-0001
Country : US
Telephone Number : 707-465-9022
Fax Number : 707-465-9161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 03/07/2023

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