Provider Demographics
NPI:1629516265
Name:MCCLEAN, MARTHALIE (RN, BSN)
Entity Type:Individual
Prefix:MISS
First Name:MARTHALIE
Middle Name:
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLINTON ST
Mailing Address - Street 2:APT 5V
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2748
Mailing Address - Country:US
Mailing Address - Phone:917-592-3205
Mailing Address - Fax:
Practice Address - Street 1:10 CLINTON ST
Practice Address - Street 2:APT 5V
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2748
Practice Address - Country:US
Practice Address - Phone:917-592-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse