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General NPI Number Information
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NPI Number | 1811375736
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Entity Type | Individual
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Provider Name | MRS. KRISTINA MARIE MCLEAN
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1020 SANSOM ST SUITE 239
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5002
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Country | US
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Telephone | 215-955-6844
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 SANSOM ST SUITE 239
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5002
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Country | US
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Telephone | 215-955-6844
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ15159300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014589
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License Number State | PA
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