Provider Demographics
NPI:1952333601
Name:MCCLELLAND, PAMELA L (CNM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:MCCLELLAND
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 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-782-4700
Practice Address - Fax:717-782-4710
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008087L176B00000X
PARN186947L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012201800008Medicaid
PA50054247OtherBLUE CROSS/CAIC
PAP00378476OtherRAILROAD MEDICARE
PA1528870OtherGATEWAY
PA178686OtherUNISON
PA1528870OtherGATEWAY
PA416822Medicare PIN