Provider Demographics
NPI:1942807854
Name:MCLEAN, MICHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 SILENT GROVE CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4186
Mailing Address - Country:US
Mailing Address - Phone:209-815-7228
Mailing Address - Fax:
Practice Address - Street 1:10503 SILENT GROVE CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4186
Practice Address - Country:US
Practice Address - Phone:209-815-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife