Provider Demographics
NPI:1083720213
Name:MCLAIN, NINA E (CRNA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:E
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:E
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2510 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9513
Mailing Address - Country:US
Mailing Address - Phone:601-355-1234
Mailing Address - Fax:601-326-3559
Practice Address - Street 1:2510 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9513
Practice Address - Country:US
Practice Address - Phone:601-355-1234
Practice Address - Fax:601-326-3559
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR634522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00361141OtherRAILROAD MEDICARE
MS00115900Medicaid
GAP00361141OtherRAILROAD MEDICARE
MSR34901Medicare UPIN