Individual
CORISA MCCLOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1025 LAWNVIEW AVE, NEWARK, OH 43055-2611
(740) 704-2349
(407) 042-3497
Mailing address
1025 LAWNVIEW AVE, NEWARK, OH 43055-2611
(740) 704-2349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
CNP.025435
OH
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.025435
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN.CNP.025435
LICENSE NUMBER
OH
Enumeration date
08/13/2019
Last updated
11/09/2020
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