Healthcare Provider Details

I. General information

NPI: 1972992642
Provider Name (Legal Business Name): MICHELLE MCCLOUD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-4042
  • Fax: 617-667-7793
Mailing address:
  • Phone: 617-667-4042
  • Fax: 617-667-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN282177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: