Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024169415 | VA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 0024169415 | VA |
NPI | 1003101536 |
---|---|
Provider Name | Melissa Ann Mcclean |
First Address | Falls Church, VA 22042-1206 |
Second Address | Falls Church, VA 22042-1206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 09/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0024169415 | LICENSE (01) | VA |