Provider Demographics
NPI:1538585559
Name:MCLEAN, JUEWELLE (NP , AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JUEWELLE
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:NP , AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N HIGH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1879
Mailing Address - Country:US
Mailing Address - Phone:914-699-2681
Mailing Address - Fax:
Practice Address - Street 1:121 N HIGH ST #2
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609523163W00000X
NYF430902-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care