Healthcare Provider Details

I. General information

NPI: 1821487588
Provider Name (Legal Business Name): KAREN J. MCCLELLAND RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD
OMAHA NE
68124-2372
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-5678
  • Fax: 402-398-6385
Mailing address:
  • Phone: 402-398-6255
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number61601
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: