=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538674411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEANN MCCLAIN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2017
-----------------------------------------------------
Last Update Date | 12/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6150 OAK TREE BLVD STE 200
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44131-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-718-0961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 CAXTON LN
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44212-6478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-263-5793
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.021957
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------