Provider Demographics
NPI:1235732744
Name:MCLENDON, PRETTY (NP)
Entity Type:Individual
Prefix:
First Name:PRETTY
Middle Name:
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28289 CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6338
Mailing Address - Country:US
Mailing Address - Phone:951-905-7848
Mailing Address - Fax:
Practice Address - Street 1:28289 CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6338
Practice Address - Country:US
Practice Address - Phone:951-905-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily