Provider Demographics
NPI:1285249516
Name:MCCLAIN, JAMILA (STNA)
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 SURREY TRL APT 5
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2711
Mailing Address - Country:US
Mailing Address - Phone:937-520-5245
Mailing Address - Fax:
Practice Address - Street 1:1862 SURREY TRL APT 5
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-2711
Practice Address - Country:US
Practice Address - Phone:937-520-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401488560213376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide