Individual
CAROL M MCCLENDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Mailing address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
142618
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
142618
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0376451
—
MA
01
—
NP9986
BLUE CROSS
MA
01
—
PN737
HARVARD PILGRIM
MA
Enumeration date
02/24/2006
Last updated
03/07/2021
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