Provider Demographics
NPI:1164694345
Name:MCCLOUD, CARMEN (MA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19071
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-0071
Mailing Address - Country:US
Mailing Address - Phone:317-658-3106
Mailing Address - Fax:317-375-6470
Practice Address - Street 1:5907 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-3235
Practice Address - Country:US
Practice Address - Phone:317-658-3106
Practice Address - Fax:317-375-6470
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48-01-04-05216376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide