Provider Demographics
NPI:1922328004
Name:MCCLAIN, ANTYONAE MARIE
Entity Type:Individual
Prefix:
First Name:ANTYONAE
Middle Name:MARIE
Last Name:MCCLAIN
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 1:1161 14TH PL # 2
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1231
Mailing Address - Country:US
Mailing Address - Phone:515-771-1031
Mailing Address - Fax:
Practice Address - Street 1:1161 14TH PL # 2
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1231
Practice Address - Country:US
Practice Address - Phone:515-771-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor