Healthcare Provider Details

I. General information

NPI: 1205249182
Provider Name (Legal Business Name): MARCIA MCCLEAN B.S.N. RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA L. MCCLEAN B.S.N. RN

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S PEORIA AVE
TULSA OK
74120-4429
US

IV. Provider business mailing address

1132 N CYPRESS AVE
BROKEN ARROW OK
74012-8562
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-9471
  • Fax: 918-560-1399
Mailing address:
  • Phone: 918-254-1833
  • Fax: 918-254-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR0068362
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: