Provider Demographics
NPI:1801662937
Name:MCLEAN, DAPHNA NAHOMIE (FNP)
Entity type:Individual
Prefix:
First Name:DAPHNA
Middle Name:NAHOMIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 PAIGE CT
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2780
Mailing Address - Country:US
Mailing Address - Phone:865-307-6402
Mailing Address - Fax:
Practice Address - Street 1:1509 PAIGE CT
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2780
Practice Address - Country:US
Practice Address - Phone:865-307-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029916207Q00000X
KS53-83146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine