Provider Demographics
NPI:1730777103
Name:MCLEAN, SHAN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SHAN
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 MCKINSTRY RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:TN
Mailing Address - Zip Code:38057-6159
Mailing Address - Country:US
Mailing Address - Phone:901-651-4489
Mailing Address - Fax:
Practice Address - Street 1:7355 MCKINSTRY RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:TN
Practice Address - Zip Code:38057-6159
Practice Address - Country:US
Practice Address - Phone:901-651-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-136968163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant