Provider Demographics
NPI:1548793250
Name:MCCLAIN, ANNETTE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29400 VAN DYKE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2320
Mailing Address - Country:US
Mailing Address - Phone:586-751-2775
Mailing Address - Fax:
Practice Address - Street 1:29400 VAN DYKE AVE
Practice Address - Street 2:STE 301
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2320
Practice Address - Country:US
Practice Address - Phone:586-751-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704150031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse