Provider Demographics
NPI:1194397034
Name:MCCLAIN, SELENA (CNP)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2709
Mailing Address - Country:US
Mailing Address - Phone:440-735-3800
Mailing Address - Fax:
Practice Address - Street 1:44 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2709
Practice Address - Country:US
Practice Address - Phone:440-735-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028894207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine