Provider Demographics
NPI:1235649880
Name:MCCLEAN, HEATHER ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2504
Mailing Address - Country:US
Mailing Address - Phone:315-782-9450
Mailing Address - Fax:315-782-1330
Practice Address - Street 1:238 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2504
Practice Address - Country:US
Practice Address - Phone:315-782-9450
Practice Address - Fax:315-782-1330
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant