Provider Demographics
NPI:1689175523
Name:MCCLURE, RITA JO (LPN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:JO
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 PINEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1850
Mailing Address - Country:US
Mailing Address - Phone:402-483-6360
Mailing Address - Fax:
Practice Address - Street 1:1000 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4217
Practice Address - Country:US
Practice Address - Phone:402-436-1302
Practice Address - Fax:402-436-1329
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16645164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty