Provider Demographics
NPI:1457722365
Name:MCCLELLAN, MELINDA R (APRN CNP)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:R
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:R
Other - Last Name:MUNCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:201 5TH ST NE STE 16
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3017
Mailing Address - Country:US
Mailing Address - Phone:330-615-3031
Mailing Address - Fax:234-312-2427
Practice Address - Street 1:201 5TH ST NE STE 16
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3017
Practice Address - Country:US
Practice Address - Phone:330-615-3031
Practice Address - Fax:234-312-2427
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18292363LF0000X
OHCOA.18292-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily