Provider Demographics
NPI:1326565342
Name:MACLEAN, MONIKA JEAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:MONIKA
Middle Name:JEAN
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 BRADHURST AVE APT 702
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2438
Mailing Address - Country:US
Mailing Address - Phone:917-834-6978
Mailing Address - Fax:
Practice Address - Street 1:53 W 23RD ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4237
Practice Address - Country:US
Practice Address - Phone:212-746-7159
Practice Address - Fax:212-746-7166
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7159363LA2200X, 363LG0600X
NY308387364SG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology