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General NPI Number Information
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NPI Number | 1578950077
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Entity Type | Organization
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Legal Business Name | DONNA L MCLEAN LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 20 MAGNOLIA AVE SUITE A
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City | BRIDGETON
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State | NJ
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Zip | 08302-1759
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Country | US
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Telephone | 856-455-7017
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Fax | 856-455-2594
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Provider Business Mailing Address
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Address Line | PO BOX 64
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City | FAIRTON
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State | NJ
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Zip | 08320-0064
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Country | US
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Telephone | 856-455-7017
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Fax | 856-455-2594
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA L MCLEAN
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Credential | CNM
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Telephone | 856-455-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 25ME00010601
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License Number State | NJ
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