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General NPI Number Information
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NPI Number | 1275429870
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Entity Type | Individual
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Provider Name | DESIREE MACLEAN
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 948 JOHNSON RIDGE RD
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City | ELKIN
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State | NC
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Zip | 28621-2212
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Country | US
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Telephone | 336-835-1467
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Fax |
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Provider Business Mailing Address
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Address Line | 225 MAC LN
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City | MOCKSVILLE
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State | NC
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Zip | 27028-8363
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Country | US
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Telephone | 336-909-1503
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5022405
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5022405
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License Number State | NC
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