Provider Demographics
NPI:1801020532
Name:MCCLAIN, BRUCE WALTER (RN)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WALTER
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27031 BENTLEY WAY
Mailing Address - Street 2:101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27031 BENTLEY WAY
Practice Address - Street 2:101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4717
Practice Address - Country:US
Practice Address - Phone:813-713-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276682163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency