Provider Demographics
NPI:1386230464
Name:MCLEAN, JODYANN (LPN)
Entity Type:Individual
Prefix:
First Name:JODYANN
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 BROADWAY APT 4D
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1951
Mailing Address - Country:US
Mailing Address - Phone:862-267-6607
Mailing Address - Fax:
Practice Address - Street 1:770 E 221ST ST APT 2F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5156
Practice Address - Country:US
Practice Address - Phone:862-267-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338321164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty