Provider Demographics
NPI:1639732910
Name:MCCLENDON, ANTOINETTE PAULINE
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:PAULINE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 ELVANS RD SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3528
Mailing Address - Country:US
Mailing Address - Phone:202-579-7710
Mailing Address - Fax:
Practice Address - Street 1:3901 13TH ST SE APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4347
Practice Address - Country:US
Practice Address - Phone:202-705-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant