Provider Demographics
NPI:1902451875
Name:MCCLURE, CHRISTELLE (DNP)
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 HANCOCK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2289
Mailing Address - Country:US
Mailing Address - Phone:973-896-8836
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST BLDG 5S
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1675
Practice Address - Country:US
Practice Address - Phone:973-994-1011
Practice Address - Fax:973-994-1220
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00942000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health