Provider Demographics
NPI:1538118351
Name:MCCLAIN, DIANE KAY (NNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 PORTUGAL DR
Mailing Address - Street 2:APT A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2345
Mailing Address - Country:US
Mailing Address - Phone:915-313-4969
Mailing Address - Fax:
Practice Address - Street 1:3210 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-6230
Practice Address - Country:US
Practice Address - Phone:915-351-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241053363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal