Provider Demographics
NPI:1164860250
Name:MCCLINTOCK-DONAHUE, ALEA LYNNE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALEA
Middle Name:LYNNE
Last Name:MCCLINTOCK-DONAHUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1371
Mailing Address - Country:US
Mailing Address - Phone:301-334-8171
Mailing Address - Fax:301-334-1819
Practice Address - Street 1:311 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-334-8171
Practice Address - Fax:301-334-1819
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD446217300Medicaid
MD446217300Medicaid