Provider Demographics
NPI:1285904508
Name:MCLENNON, CLOVER R (RN)
Entity type:Individual
Prefix:MRS
First Name:CLOVER
Middle Name:R
Last Name:MCLENNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40A LOCUST HILL AVE # A
Mailing Address - Street 2:APT 5I
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3066
Mailing Address - Country:US
Mailing Address - Phone:718-908-8341
Mailing Address - Fax:914-613-7981
Practice Address - Street 1:40A LOCUST HILL AVE # A
Practice Address - Street 2:APT 5I
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3066
Practice Address - Country:US
Practice Address - Phone:718-908-8341
Practice Address - Fax:914-613-7981
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY652245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse