Provider Demographics
NPI:1851285795
Name:MCLEAN, JAN JESSIE
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:JESSIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
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 74
Mailing Address - Street 2:
Mailing Address - City:MOHALL
Mailing Address - State:ND
Mailing Address - Zip Code:58761-0074
Mailing Address - Country:US
Mailing Address - Phone:701-389-1624
Mailing Address - Fax:
Practice Address - Street 1:504 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:MOHALL
Practice Address - State:ND
Practice Address - Zip Code:58761-4059
Practice Address - Country:US
Practice Address - Phone:701-389-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant