Provider Demographics
NPI:1629094362
Name:MCCLURE, PATRICIA (APRN, PMH-NP BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:APRN, PMH-NP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3831
Mailing Address - Country:US
Mailing Address - Phone:860-442-6567
Mailing Address - Fax:860-440-3620
Practice Address - Street 1:7 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-3831
Practice Address - Country:US
Practice Address - Phone:860-442-6567
Practice Address - Fax:860-440-3620
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002906363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health