Provider Demographics
NPI:1912770512
Name:MCCLENDON, MARIAH MERCEDES (RN)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:MERCEDES
Last Name:MCCLENDON
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 1:1020 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2846
Mailing Address - Country:US
Mailing Address - Phone:336-429-7508
Mailing Address - Fax:
Practice Address - Street 1:1020 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2846
Practice Address - Country:US
Practice Address - Phone:336-429-7508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC315273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse