Provider Demographics
NPI:1962225664
Name:MCCLAMY, VANISHA (CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:VANISHA
Middle Name:
Last Name:MCCLAMY
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:VANISHA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP, FNP-BC
Mailing Address - Street 1:315 N 12TH ST APT 716
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1224
Mailing Address - Country:US
Mailing Address - Phone:267-987-2494
Mailing Address - Fax:
Practice Address - Street 1:4430 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-1312
Practice Address - Country:US
Practice Address - Phone:215-964-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN715164163W00000X
PASP031149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse