Provider Demographics
NPI:1194740555
Name:MCCLELLAND, JOAN Q (CFNP)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:Q
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
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Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2275
Mailing Address - Country:US
Mailing Address - Phone:505-662-4351
Mailing Address - Fax:505-662-2932
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-662-4351
Practice Address - Fax:505-662-2932
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMR30440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97528Medicaid
NMNM006287OtherBCBS NM
2202010923OtherPRESBYTERIAN HEALTH PLANS
2385852OtherUHC
100005460OtherLOVELACE
0009444161OtherPHCS
PROVP14420OtherMOLINA
NMNM006287OtherBCBS NM
2385852OtherUHC