Provider Demographics
NPI:1518503606
Name:MCCLELLAN, CONNOR ROSS
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:ROSS
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MELBA PL APT 7
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4141
Mailing Address - Country:US
Mailing Address - Phone:412-719-3171
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2543
Practice Address - Country:US
Practice Address - Phone:412-624-4860
Practice Address - Fax:412-624-1508
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN671142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse