MEDICARE: DESTINYE ELAINE MCLEAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor
2	177F00000X	Lodging Provider
3	251J00000X	Nursing Care Agency
4	374T00000X	Religious Nonmedical Nursing Personnel
5	163W00000X	Registered Nurse	273130	SC

General Provider Information

NPI Number	:	1093272221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINYE ELAINE MCLEAN RN

Provider Business Mailing Address
First Line	:	1323 W RIVERVIEW AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6216
Country	:	US
Telephone Number	:	908-590-5283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 W RIVERVIEW AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6216
Country	:	US
Telephone Number	:	908-590-5283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2019
Last Update Date	:	04/24/2025

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