Provider Demographics
NPI:1336686930
Name:MCCLAM, SKYELAR (RN)
Entity Type:Individual
Prefix:MRS
First Name:SKYELAR
Middle Name:
Last Name:MCCLAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 DELOS RD
Mailing Address - Street 2:
Mailing Address - City:CADES
Mailing Address - State:SC
Mailing Address - Zip Code:29518-3373
Mailing Address - Country:US
Mailing Address - Phone:843-598-6253
Mailing Address - Fax:
Practice Address - Street 1:1104 DELOS RD
Practice Address - Street 2:
Practice Address - City:CADES
Practice Address - State:SC
Practice Address - Zip Code:29518-3373
Practice Address - Country:US
Practice Address - Phone:843-598-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse