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General NPI Number Information
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NPI Number | 1427410737
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Entity Type | Individual
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Provider Name | NICHOLAS JOHN MCCLELLAN DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-5703
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Country | US
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Telephone | 715-387-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-5702
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Country | US
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Telephone | 517-302-2625
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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 | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | 5101026041
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | 71985
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License Number State | WI
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