Provider Demographics
NPI:1710024138
Name:MCCLELLAND, MARIE I (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:MCCLELLAND
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4648
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-4648
Mailing Address - Country:US
Mailing Address - Phone:865-453-1032
Mailing Address - Fax:865-428-2689
Practice Address - Street 1:227 CEDAR ST
Practice Address - Street 2:227 CEDAR ST.
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3838
Practice Address - Country:US
Practice Address - Phone:865-453-1032
Practice Address - Fax:865-428-2689
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000041504251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management