Provider Demographics
NPI:1851706139
Name:MCCLAIN, JERRIE (RN)
Entity Type:Individual
Prefix:
First Name:JERRIE
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17606 COSHOCTON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9218
Mailing Address - Country:US
Mailing Address - Phone:740-397-0533
Mailing Address - Fax:740-397-0350
Practice Address - Street 1:17606 COSHOCTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9218
Practice Address - Country:US
Practice Address - Phone:740-397-0533
Practice Address - Fax:740-397-0350
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN247576163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health