Healthcare Provider Details

I. General information

NPI: 1053537837
Provider Name (Legal Business Name): LORRAINE MARY MCLEAN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 MAIN ST SUITE 203
FAIRFAX VA
22030-6903
US

IV. Provider business mailing address

12236 OX HILL RD
FAIRFAX VA
22033-2405
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-2433
  • Fax:
Mailing address:
  • Phone: 703-620-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024084353
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: