Provider Demographics
NPI:1487544607
Name:MCLEAN, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:SC
Mailing Address - Zip Code:29567-0035
Mailing Address - Country:US
Mailing Address - Phone:843-632-2215
Mailing Address - Fax:
Practice Address - Street 1:1404 MCCOYS CHAPEL ST
Practice Address - Street 2:1404 M
Practice Address - City:LITTLE ROCK
Practice Address - State:SC
Practice Address - Zip Code:29567-2956
Practice Address - Country:US
Practice Address - Phone:843-632-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty