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Individual
LAURA SUE MCCLENNY
Active
Individual
LAURA SUE MCCLENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
669980
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211234401
—
TX
01
—
75-2616977-118
TRICARE
TX
01
—
817N75
BCBS
TX
01
—
P00820916
RAIL ROAD MEDICARE
TX
01
—
TIN PLUS 020
TRICARE
TX
Enumeration date
03/09/2010
Last updated
10/13/2014
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