Provider Demographics
NPI:1962047985
Name:MCCLURE, TANISHA (LVN)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WALDROP ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2836
Mailing Address - Country:US
Mailing Address - Phone:469-428-3078
Mailing Address - Fax:
Practice Address - Street 1:1711 WALDROP ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2836
Practice Address - Country:US
Practice Address - Phone:469-428-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320613164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse