Provider Demographics
NPI:1770692592
Name:MCCLELLAND, LOIS (CNM)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054
Mailing Address - Country:US
Mailing Address - Phone:440-949-6024
Mailing Address - Fax:
Practice Address - Street 1:3311 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3315
Practice Address - Country:US
Practice Address - Phone:216-661-0400
Practice Address - Fax:216-661-2238
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01873NM367A00000X
OHRN160940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0683952Medicaid
OHNM03791Medicare PIN