Provider Demographics
NPI:1225250558
Name:MCCLURE, D SUZANNE
Entity Type:Individual
Prefix:MRS
First Name:D
Middle Name:SUZANNE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINE LANE
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-8019
Mailing Address - Country:US
Mailing Address - Phone:217-323-3442
Mailing Address - Fax:217-323-5522
Practice Address - Street 1:903 SOUTH FIRST STREET
Practice Address - Street 2:APARTMENT 122
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6086
Practice Address - Country:US
Practice Address - Phone:217-836-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant