Provider Demographics
NPI:1659697506
Name:MCCLAINE, MARCIA SHARELL
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:SHARELL
Last Name:MCCLAINE
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 1:4305 HASTINGS CT E
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7707
Mailing Address - Country:US
Mailing Address - Phone:540-898-3489
Mailing Address - Fax:
Practice Address - Street 1:4305 HASTINGS CT E
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7707
Practice Address - Country:US
Practice Address - Phone:540-898-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001192400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse