Provider Demographics
NPI:1023147766
Name:MCCUEN, JOAN CORNELIA (APN, PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:CORNELIA
Last Name:MCCUEN
Suffix:
Gender:F
Credentials:APN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-656-9030
Mailing Address - Fax:
Practice Address - Street 1:2200 21ST AVE S STE 305
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4929
Practice Address - Country:US
Practice Address - Phone:615-310-8551
Practice Address - Fax:615-292-9323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008438363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087312OtherBCBS PROVIDER ID