Provider Demographics
NPI:1316688716
Name:MCCLURE, NICHOLAS ALEXANDER (RN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2662
Mailing Address - Country:US
Mailing Address - Phone:231-346-5216
Mailing Address - Fax:
Practice Address - Street 1:747 E EIGHTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2662
Practice Address - Country:US
Practice Address - Phone:231-346-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703124548164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse