Individual
MARY M MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2000 BOISE AVE, LOVELAND, CO 80538-5006
(970) 669-4640
Mailing address
PO BOX 52631, PHOENIX, AZ 85072-2631
(970) 395-7878
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
62279
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36832375
—
CO
Enumeration date
11/03/2005
Last updated
01/04/2012
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