Individual
NICOLE LEE MCCLELLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
760 GOLF VIEW DR, SUITE # 200, MEDFORD, OR 97504-9685
(541) 618-4400
(541) 618-4406
Mailing address
760 GOLF VIEW DR, SUITE # 200, MEDFORD, OR 97504-9685
(541) 618-4400
(541) 618-4406
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
110995
NE
363L00000X
Nurse Practitioner
1824
NE
363L00000X
Nurse Practitioner
Primary
201050102NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110995
APRN STATE LICENSE
NE
01
—
201041420RN
STATE LICENSE - RN
OR
01
—
201050102NP
STATE - ANP
OR
05
—
500629049
—
OR
01
—
52664
RN STATE LICENSE
NE
Enumeration date
10/08/2008
Last updated
07/01/2013
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