Provider Demographics
NPI:1598988248
Name:MCLEAN, CAROL PATRICIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:PATRICIA
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 LANDOVER RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1016
Mailing Address - Country:US
Mailing Address - Phone:301-955-0744
Mailing Address - Fax:
Practice Address - Street 1:6126 LANDOVER RD UNIT 3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1016
Practice Address - Country:US
Practice Address - Phone:301-955-0744
Practice Address - Fax:440-408-3200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131588310400000X, 314000000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility