Provider Demographics
NPI:1932678604
Name:MCCLEAN, MELISSA MELANIE (NP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MELANIE
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:MELANIE
Other - Last Name:MCCLEAN JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3863 THORNCROFT LN UNIT N
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-3419
Mailing Address - Country:US
Mailing Address - Phone:323-384-3252
Mailing Address - Fax:
Practice Address - Street 1:3863 THORNCROFT LN UNIT N
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-3419
Practice Address - Country:US
Practice Address - Phone:323-384-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2017037652363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care