MEDICARE: LAURA MCLEAN NP

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	363LN0000X	Neonatal Nurse Practitioner	3016358	KY
2	363L00000X	Nurse Practitioner	4704192085	MI
3	363LN0005X	Critical Care Neonatal Nurse Practitioner	RN164307	AZ

General Provider Information

NPI Number	:	1396946919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCLEAN NP

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5073
Country	:	US
Telephone Number	:	520-634-4132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5073
Country	:	US
Telephone Number	:	520-634-4132
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	12/16/2021

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