Provider Demographics
NPI:1689842627
Name:MCCLELLAND, JOANA (LPN)
Entity Type:Individual
Prefix:
First Name:JOANA
Middle Name:
Last Name:MCCLELLAND
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 1:633 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54013-9762
Mailing Address - Country:US
Mailing Address - Phone:715-565-4310
Mailing Address - Fax:
Practice Address - Street 1:1300 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9395
Practice Address - Country:US
Practice Address - Phone:715-684-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse