Provider Demographics
NPI:1205249182
Name:MCCLEAN, MARCIA (BSN RN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:L
Other - Last Name:MCCLEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN RN
Mailing Address - Street 1:1132 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8562
Mailing Address - Country:US
Mailing Address - Phone:918-254-1833
Mailing Address - Fax:918-254-7155
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068362163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health