Provider Demographics
NPI:1952865735
Name:MCLEAN, VANNY (NP)
Entity Type:Individual
Prefix:
First Name:VANNY
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANNY
Other - Middle Name:
Other - Last Name:TRIEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-0699
Mailing Address - Country:US
Mailing Address - Phone:781-404-7045
Mailing Address - Fax:
Practice Address - Street 1:72 E CONCORD STREET
Practice Address - Street 2:ROBINSON 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-6100
Practice Address - Fax:617-638-6179
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267891363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty