Provider Demographics
NPI:1487747879
Name:MCCLANAHAN, SONDRA L (FNP)
Entity type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:L
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:178 GREENSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8357
Mailing Address - Country:US
Mailing Address - Phone:636-379-3415
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR
Practice Address - Street 2:SUITE 222
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4771
Practice Address - Country:US
Practice Address - Phone:636-978-8600
Practice Address - Fax:636-978-8602
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO105589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152800021Medicare PIN