Provider Demographics
NPI:1871242016
Name:MCLEAN-COLLINS, SHAVON (LPN)
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:MCLEAN-COLLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ACORN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3825
Mailing Address - Country:US
Mailing Address - Phone:774-534-8172
Mailing Address - Fax:
Practice Address - Street 1:26 ACORN ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3825
Practice Address - Country:US
Practice Address - Phone:774-534-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN95988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse