Provider Demographics
NPI:1689487522
Name:MCCLANAHAN, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MCCLANAHAN
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 1:3877 YOUNGS MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:DILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26617-9721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3877 YOUNGS MONUMENT RD
Practice Address - Street 2:
Practice Address - City:DILLE
Practice Address - State:WV
Practice Address - Zip Code:26617-9721
Practice Address - Country:US
Practice Address - Phone:681-460-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide