Healthcare Provider Details

I. General information

NPI: 1437908316
Provider Name (Legal Business Name): EMMA CLELLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SURRATTS RD STE 304
CLINTON MD
20735-3377
US

IV. Provider business mailing address

179 CEDAR LK E
DENVILLE NJ
07834-1870
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8000
  • Fax:
Mailing address:
  • Phone: 973-830-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14931200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: