Provider Demographics
NPI:1700531860
Name:MCCLURE, DAWN RAE
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RAE
Last Name:MCCLURE
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 1:3207 BOROWICK CIR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8312
Mailing Address - Country:US
Mailing Address - Phone:502-630-9609
Mailing Address - Fax:502-237-3133
Practice Address - Street 1:3207 BOROWICK CIR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8312
Practice Address - Country:US
Practice Address - Phone:502-630-9609
Practice Address - Fax:502-237-3133
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care