Provider Demographics
NPI:1558368357
Name:MCLEAN, WILLIAM M (APN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:FAIRTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08320-0064
Mailing Address - Country:US
Mailing Address - Phone:609-501-1549
Mailing Address - Fax:
Practice Address - Street 1:86 RAMAH RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-6944
Practice Address - Country:US
Practice Address - Phone:609-501-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05681700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7264704Medicaid
NJS92439Medicare UPIN
NJ7264704Medicaid