Healthcare Provider Details

I. General information

NPI: 1508089079
Provider Name (Legal Business Name): MAUREEN MCLEAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 LAKE EARL DR
CRESCENT CITY CA
95532-0001
US

IV. Provider business mailing address

750 ELK CREEK RD
CRESCENT CITY CA
95531-8589
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-9022
  • Fax: 707-465-9161
Mailing address:
  • Phone: 707-464-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number325122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: