Provider Demographics
NPI:1952467342
Name:MCCLURE, ELIZABETH (PPCNPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PPCNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9155
Mailing Address - Country:US
Mailing Address - Phone:740-695-4026
Mailing Address - Fax:740-695-4025
Practice Address - Street 1:157 E LAWN AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9155
Practice Address - Country:US
Practice Address - Phone:740-695-4026
Practice Address - Fax:740-695-4025
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06505RX363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290962Medicaid
OH2290962Medicaid