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General NPI Number Information
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NPI Number | 1255790416
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Entity Type | Individual
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Provider Name | BETH MCLELLAN
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Gender | Female
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 3031 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-3046
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Country | US
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Telephone | 313-916-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 12239 LESSARD ST.
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City | TECUMSEH
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State | ONTARIO
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Zip | N8N 4M1
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Country | CA
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Telephone | 519-962-9195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704209596
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License Number State | MI
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