Provider Demographics
NPI:1023730751
Name:MCLELLAND, JENNIFER SUSANNAH
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSANNAH
Last Name:MCLELLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5046
Mailing Address - Country:US
Mailing Address - Phone:559-824-9985
Mailing Address - Fax:
Practice Address - Street 1:1724 N CHESTERFIELD LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5046
Practice Address - Country:US
Practice Address - Phone:559-824-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727646164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse