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General NPI Number Information
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NPI Number | 1689635724
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Entity Type | Organization
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Legal Business Name | MARILYN J. MCCLURE
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3536 MENDOCINO AVE SUITE 360
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City | SANTA ROSA
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State | CA
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Zip | 95403-3634
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Country | US
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Telephone | 707-577-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 448 SEAFOAM RD
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City | SHELTER COVE
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State | CA
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Zip | 95589-9107
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Country | US
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Telephone | 707-986-7176
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. MARILYN JEANNE MCCLURE
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Credential | MSN-FNP
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Telephone | 707-986-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C148295
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License Number State | CA
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