Provider Demographics
NPI:1497439723
Name:MCCLAIN, DEANNA ELIZABETH
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ELIZABETH
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4831 YOEST DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9644
Mailing Address - Country:US
Mailing Address - Phone:419-989-5131
Mailing Address - Fax:
Practice Address - Street 1:3100 EASTON SQUARE PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6289
Practice Address - Country:US
Practice Address - Phone:614-546-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.460134163W00000X
OHAPRN.CNP.0034615363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse