Provider Demographics
NPI:1558835603
Name:MCCLELLAND, MOLLY LYNN (PHD, RN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYNN
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:PHD, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W 14 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-655-1400
Mailing Address - Fax:248-655-2646
Practice Address - Street 1:555 W 14 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-655-1400
Practice Address - Fax:248-655-2646
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704168241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health