1396261293 NPI number — COLLEEN E MCCLAY CRNP

Table of content: EFDGYNE MICHEL (NPI 1750041984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396261293 NPI number — COLLEEN E MCCLAY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAY
Provider First Name:
COLLEEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396261293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 ROBINS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYLORSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18353-8099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-707-1737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NORTHAMPTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
445-448-1623
Provider Business Practice Location Address Fax Number:
307-248-1623
Provider Enumeration Date:
08/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP018039 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP018039 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103485042 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ORP , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100730753 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111893300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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