Provider Demographics
NPI:1588182430
Name:MCCLELLAND, AMANDA W (MSN WHNP RN IBCLC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:W
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:MSN WHNP RN IBCLC
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Mailing Address - Street 1:160 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-1279
Mailing Address - Country:US
Mailing Address - Phone:740-683-9932
Mailing Address - Fax:
Practice Address - Street 1:100 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1809
Practice Address - Country:US
Practice Address - Phone:740-344-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH021506363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health