Provider Demographics
NPI:1750442307
Name:MCLELLAN, MAUREEN FRANCES (RN PNP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:FRANCES
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:RN PNP
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:FRANCES
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6189 E 25TH LANE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:928-726-3706
Mailing Address - Fax:
Practice Address - Street 1:YUMA PEDIATRICS
Practice Address - Street 2:2359 S 22ND DR SUITE 2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-4800
Practice Address - Fax:928-726-2377
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN034143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner