Healthcare Provider Details

I. General information

NPI: 1558368357
Provider Name (Legal Business Name): WILLIAM M MCLEAN APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 RAMAH RD
BRIDGETON NJ
08302-6944
US

IV. Provider business mailing address

PO BOX 64
FAIRTON NJ
08320-0064
US

V. Phone/Fax

Practice location:
  • Phone: 609-501-1549
  • Fax:
Mailing address:
  • Phone: 609-501-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN05681700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: