Provider Demographics
NPI:1750118915
Name:MCCLURE, MAHALA REBECCA
Entity type:Individual
Prefix:
First Name:MAHALA
Middle Name:REBECCA
Last Name:MCCLURE
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 1:510 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1520
Mailing Address - Country:US
Mailing Address - Phone:636-582-0599
Mailing Address - Fax:
Practice Address - Street 1:510 RUTH AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1520
Practice Address - Country:US
Practice Address - Phone:636-582-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula