Basic Information
Provider Information
NPI: 1902106073
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCLEAN
FirstName: MARGARET
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: CNS-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber: 2146458600
FaxNumber: 2146458601
Practice Location
Address1: 5323 HARRY HINES BOULEVARD
Address2:  
City: DALLAS
State: TX
PostalCode: 753907201
CountryCode: US
TelephoneNumber: 2146458600
FaxNumber: 2146458601
Other Information
ProviderEnumerationDate: 10/23/2010
LastUpdateDate: 06/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364S00000X761825TXY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist 

No ID Information.


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