Provider Demographics
NPI:1245831320
Name:MCCLENON, MORGAN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:MARIE
Last Name:MCCLENON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:TROUT CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13847-0043
Mailing Address - Country:US
Mailing Address - Phone:607-761-8554
Mailing Address - Fax:
Practice Address - Street 1:8253 STATE HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:TROUT CREEK
Practice Address - State:NY
Practice Address - Zip Code:13847
Practice Address - Country:US
Practice Address - Phone:607-832-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677735-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse