Provider Demographics
NPI:1588088447
Name:MCCLAIN, BETH (RN, BSN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8158 HIDDEN GLEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1786
Mailing Address - Country:US
Mailing Address - Phone:330-966-7830
Mailing Address - Fax:
Practice Address - Street 1:1400 BROAD AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3129
Practice Address - Country:US
Practice Address - Phone:330-456-1963
Practice Address - Fax:330-456-8121
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN214479163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse