Provider Demographics
NPI:1215277330
Name:MCLEAN, ROSEMARIE R
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:R
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 197TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1708
Mailing Address - Country:US
Mailing Address - Phone:718-740-2804
Mailing Address - Fax:718-740-2804
Practice Address - Street 1:10912 197TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1708
Practice Address - Country:US
Practice Address - Phone:718-740-2804
Practice Address - Fax:718-740-2804
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613588163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse