Provider Demographics
NPI:1932332939
Name:MCLEAN, SHONNA OLIVIA (FNP)
Entity Type:Individual
Prefix:
First Name:SHONNA
Middle Name:OLIVIA
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHONNA
Other - Middle Name:OLIVIA
Other - Last Name:THARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:3024 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:919-350-7945
Practice Address - Fax:919-350-8091
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA744863163W00000X
SC3990363L00000X
NC174231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1932332939Medicaid
SC5677Medicare PIN
NC1932332939Medicaid