MEDICARE: CAROL PATRICIA MCLEAN NURSE PRACTITIONER

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	310400000X	Assisted Living Facility	R131588	MD
2	314000000X	Skilled Nursing Facility	R131588	MD
3	363LA2200X	Adult Health Nurse Practitioner	R131588	MD

General Provider Information

NPI Number	:	1598988248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL PATRICIA MCLEAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6126 LANDOVER RD UNIT 3
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1016
Country	:	US
Telephone Number	:	301-955-0744
Fax Number	:

Provider Business Practice Location Address
First Line	:	6126 LANDOVER RD UNIT 3
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1016
Country	:	US
Telephone Number	:	301-955-0744
Fax Number	:	440-408-3200

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/04/2020

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Directions to “ CAROL PATRICIA MCLEAN NURSE PRACTITIONER” Practice Location

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