Healthcare Provider Details

I. General information

NPI: 1396891792
Provider Name (Legal Business Name): JESSE V MCCLAIN CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BELMONT AVE STE 2200
YOUNGSTOWN OH
44504-1125
US

IV. Provider business mailing address

1340 BELMONT AVE STE 2200
YOUNGSTOWN OH
44504-1125
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7400
  • Fax: 330-746-7436
Mailing address:
  • Phone: 330-746-7400
  • Fax: 330-746-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN.CNS.09249
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: