Healthcare Provider Details

I. General information

NPI: 1093272221
Provider Name (Legal Business Name): DESTINYE ELAINE MCLEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W RIVERVIEW AVE
DAYTON OH
45402-6216
US

IV. Provider business mailing address

1323 W RIVERVIEW AVE
DAYTON OH
45402-6216
US

V. Phone/Fax

Practice location:
  • Phone: 908-590-5283
  • Fax:
Mailing address:
  • Phone: 908-590-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number273130
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: