Healthcare Provider Details

I. General information

NPI: 1588728232
Provider Name (Legal Business Name): GLENDA K MCLEAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 EBRIGHT RD
WILMINGTON DE
19810-1125
US

IV. Provider business mailing address

208 EILEENS WAY
HOCKESSIN DE
19707-9196
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-3960
  • Fax:
Mailing address:
  • Phone: 302-477-3860
  • Fax: 302-477-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ-0000193
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: