Healthcare Provider Details

I. General information

NPI: 1518118587
Provider Name (Legal Business Name): JENNIFER L MCCLENDON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 2
FPO AE
09617
US

IV. Provider business mailing address

PSC 827 BOIX 2
NAPLES ITALY
FPO AE 09617
IT

V. Phone/Fax

Practice location:
  • Phone: 81-629-6475
  • Fax:
Mailing address:
  • Phone: -629-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number677635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: