Provider Demographics
NPI:1508089079
Name:MCLEAN, MAUREEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ELK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8589
Mailing Address - Country:US
Mailing Address - Phone:707-464-6789
Mailing Address - Fax:
Practice Address - Street 1:5905 LAKE EARL DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95532-0001
Practice Address - Country:US
Practice Address - Phone:707-465-9022
Practice Address - Fax:707-465-9161
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
13273OtherNURSE PRACTITIONER CERTIF
CA13273OtherFURNISHING NUMBER
CA325122OtherRN LICENSE
CA325122OtherRN LICENSE