Provider Demographics
NPI:1710180088
Name:MCLEAN, BARBARA BONNIE BUTT (OMD AP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA BONNIE
Middle Name:BUTT
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:OMD AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-470-0777
Mailing Address - Fax:850-469-0644
Practice Address - Street 1:675 #B W GARDEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-469-0605
Practice Address - Fax:850-469-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP959171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist