Provider Demographics
NPI:1346082773
Name:MCCLURE, ANDREW IAN (RN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:IAN
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 1:2157 ARBOR CIR W APT 108
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3435
Mailing Address - Country:US
Mailing Address - Phone:586-625-2541
Mailing Address - Fax:
Practice Address - Street 1:303 E KEARSLEY ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1907
Practice Address - Country:US
Practice Address - Phone:810-762-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704346890390200000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse