Provider Demographics
NPI:1225005010
Name:CLEARY, MYRA M (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:M
Last Name:CLEARY
Suffix:
Gender:F
Credentials:DNP, CPNP
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 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:667-214-1781
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025798363LP0200X
NVAPN000860363LP0200X
MDR205967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC2022OtherBXBS
NV100507055Medicaid
NV100507054Medicaid
NV530334OtherNEVADACARE COMM,MCAID