Provider Demographics
NPI:1740570068
Name:MCLEAN, COURTNEY KISER (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KISER
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8200 DODGE STREET
Mailing Address - Street 2:NEONATOLOGY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-6140
Mailing Address - Fax:302-651-5952
Practice Address - Street 1:8200 DODGE STREET
Practice Address - Street 2:NEONATOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-6140
Practice Address - Fax:302-651-5952
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE298822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program