MEDICARE: PAULA MCLANE

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	163W00000X	Registered Nurse	4704246013	MI

General Provider Information

NPI Number	:	1134576853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA MCLANE

Provider Business Mailing Address
First Line	:	2400 W CROWN DR UNIT 1
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-6715
Country	:	US
Telephone Number	:	231-883-7936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W CROWN DR UNIT 1
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-6715
Country	:	US
Telephone Number	:	231-883-7936
Fax Number	:

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	05/23/2016

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