Provider Demographics
NPI:1871554840
Name:MCLEAN, DONNA L (CNM)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:MCLEAN
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 1:20 MAGNOLIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1759
Mailing Address - Country:US
Mailing Address - Phone:856-455-7017
Mailing Address - Fax:
Practice Address - Street 1:20 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1759
Practice Address - Country:US
Practice Address - Phone:856-455-7017
Practice Address - Fax:856-455-2594
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00010601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1917803Medicaid
617530Medicare UPIN
NJ1917803Medicaid