Provider Demographics
NPI:1669473401
Name:MCLANE, MARY E (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:MCLANE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 S CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3503
Mailing Address - Country:US
Mailing Address - Phone:717-413-6742
Mailing Address - Fax:717-391-6593
Practice Address - Street 1:123 S CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3503
Practice Address - Country:US
Practice Address - Phone:717-413-6742
Practice Address - Fax:717-391-6593
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008599L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018236300001Medicaid