Provider Demographics
NPI:1922605674
Name:MCLEAN, JENIFER NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:NICOLE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LA PERA CT APT 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-3069
Mailing Address - Country:US
Mailing Address - Phone:707-731-7531
Mailing Address - Fax:
Practice Address - Street 1:25 LA PERA CT APT 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3069
Practice Address - Country:US
Practice Address - Phone:707-731-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264270164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse