Provider Demographics
NPI:1578950077
Name:DONNA L MCLEAN LLC
Entity Type:Organization
Organization Name:DONNA L MCLEAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:856-455-7017
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:856-455-7017
Mailing Address - Fax:856-455-2594
Practice Address - Street 1:20 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1759
Practice Address - Country:US
Practice Address - Phone:856-455-7017
Practice Address - Fax:856-455-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00010601176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty