Provider Demographics
NPI:1407891435
Name:MCLEAN, DEEDDA (CNM)
Entity Type:Individual
Prefix:
First Name:DEEDDA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1927
Mailing Address - Country:US
Mailing Address - Phone:970-986-3622
Mailing Address - Fax:970-683-5249
Practice Address - Street 1:900 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4226
Practice Address - Country:US
Practice Address - Phone:970-252-2542
Practice Address - Fax:970-252-2544
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4843176B00000X
COAPN.0004843-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62150821Medicaid
CO62150821Medicaid