Provider Demographics
NPI:1659159887
Name:MCCLANAHAN, ANITA LEANN
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LEANN
Last Name:MCCLANAHAN
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 1:280 GRAPEVINE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:WV
Mailing Address - Zip Code:24811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 GRAPEVINE BRANCH RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:WV
Practice Address - Zip Code:24811
Practice Address - Country:US
Practice Address - Phone:304-967-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant