Provider Demographics
NPI:1528780988
Name:FEE, MADELINE GRACE MCCLURE (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:GRACE MCCLURE
Last Name:FEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34213 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2875
Mailing Address - Country:US
Mailing Address - Phone:949-248-4547
Mailing Address - Fax:
Practice Address - Street 1:34213 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2875
Practice Address - Country:US
Practice Address - Phone:949-248-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant