Provider Demographics
NPI:1689910028
Name:MCLEAN, JUANITA
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:MCLEAN
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 1:736 NORTH WALDOBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-5663
Mailing Address - Country:US
Mailing Address - Phone:207-832-5154
Mailing Address - Fax:
Practice Address - Street 1:736 N. WALDOBORO ROAD
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-5663
Practice Address - Country:US
Practice Address - Phone:207-832-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker