Provider Demographics
NPI:1093858516
Name:MCLAREN, ANDREA SIDONIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SIDONIE
Last Name:MCLAREN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:141 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7058
Mailing Address - Country:US
Mailing Address - Phone:570-977-7100
Mailing Address - Fax:570-619-7416
Practice Address - Street 1:1519 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7576
Practice Address - Country:US
Practice Address - Phone:570-421-9876
Practice Address - Fax:570-421-9874
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMW008552L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019057710001Medicaid
PA084867TC1Medicare ID - Type Unspecified
PA0019057710001Medicaid