Provider Demographics
NPI:1598841348
Name:MCCLAIN, IRENE B (MSN, CDE, FNP-BC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:B
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MSN, CDE, FNP-BC
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Mailing Address - Street 1:920 2ND AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-3318
Mailing Address - Country:US
Mailing Address - Phone:612-659-7111
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:337 MAPLE AVE E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4717
Practice Address - Country:US
Practice Address - Phone:703-281-4444
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018845ZCCUMedicare PIN
DCQ62583Medicare UPIN