Healthcare Provider Details

I. General information

NPI: 1972697258
Provider Name (Legal Business Name): JENNIFER MCCLEERY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SPRING ST 450
SILVER SPRING MD
20910-2735
US

IV. Provider business mailing address

1108 16TH ST NW
WASHINGTON DC
20036-4802
US

V. Phone/Fax

Practice location:
  • Phone: 301-608-3448
  • Fax: 202-783-1007
Mailing address:
  • Phone: 202-347-8500
  • Fax: 202-783-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR110504
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: