Provider Demographics
NPI:1487002754
Name:MCCLURE, CHERYL LYNN (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:MCCLURE
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 1:24 CRESTWOOD DR APT 6A
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-3200
Mailing Address - Country:US
Mailing Address - Phone:207-341-3371
Mailing Address - Fax:
Practice Address - Street 1:11 EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-3309
Practice Address - Country:US
Practice Address - Phone:207-453-4708
Practice Address - Fax:207-453-6250
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER043082163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse