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General NPI Number Information
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NPI Number | 1457111700
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Entity Type | Individual
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Provider Name | KYLE MCLEAN NRP, CPT
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Gender | Male
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES RD STE 1000A
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City | SHELBURNE
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State | VT
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Zip | 05482-7812
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Country | US
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Telephone | 203-695-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 145 PINE HAVEN SHORES RD STE 1000A
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City | SHELBURNE
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State | VT
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Zip | 05482-7812
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Country | US
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Telephone | 203-695-7210
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 106027
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | E6K2Z3J8
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License Number State |
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