Provider Demographics
NPI:1659991578
Name:MCLACHLAN, JOHN GLENN (APRN FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GLENN
Last Name:MCLACHLAN
Suffix:
Gender:M
Credentials:APRN FNP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:GLENN
Other - Last Name:MCLACHLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN FNP
Mailing Address - Street 1:764 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3429
Mailing Address - Country:US
Mailing Address - Phone:702-686-5706
Mailing Address - Fax:
Practice Address - Street 1:764 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-3429
Practice Address - Country:US
Practice Address - Phone:702-686-5706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN54510163WC0200X, 163WC0400X, 163WE0003X
AZRN065812163WC0200X, 163WC0400X, 163WE0003X
CORN104908163WC0200X, 163WC0400X, 163WE0003X
NV830024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WE0003XNursing Service ProvidersRegistered NurseEmergency