Basic Information
| Provider Information | |||||||||
| NPI: | 1003487752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLELLAN | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 TUTTLE CREEK BLVD LOT 21 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665027121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858062220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857763322 | ||||||||
| FaxNumber: | 7857762803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2021 | ||||||||
| LastUpdateDate: | 07/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 23-25861-071 | KS | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.