Healthcare Provider Details

I. General information

NPI: 1609185305
Provider Name (Legal Business Name): MARYLOU MCCLELLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

IV. Provider business mailing address

271 GREENCREST DR
SPRING CREEK NV
89815-5447
US

V. Phone/Fax

Practice location:
  • Phone: 775-748-1400
  • Fax:
Mailing address:
  • Phone: 775-753-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN55312
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: