Provider Demographics
NPI:1285186585
Name:MCCLEARY, MARISSA SUE (APRN FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:SUE
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:SUE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN FNP-BC
Mailing Address - Street 1:610 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1655
Mailing Address - Country:US
Mailing Address - Phone:740-622-0033
Mailing Address - Fax:740-622-0210
Practice Address - Street 1:610 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1655
Practice Address - Country:US
Practice Address - Phone:740-622-0033
Practice Address - Fax:740-622-0210
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0425776Medicaid
OH363800Medicare PIN