Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 26NC07080600 | NJ |
NPI | 1003810755 |
---|---|
Provider Name | Diane E Mcclure |
First Address | Hartford, CT 06150-2730 |
Second Address | Paterson, NJ 07503-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0053546 | (05) | NJ |