| Doctor Name: | MS. LISA MARIE MCCLURE |
| NPI Number: | 1083013353 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | APRN76097NP |
| Business Practice Address: | 500 Poplar St Suite 202 South Charleston, WV - 253091474 |
| Business Phone Number: | 3043462121 |
| Business Fax Number: | 3043462176 |
| Mailing Address: | # L-3539, COLUMBUS |
| State: | OH |
| Postal Code: | 432600001 |
| Phone Number: | 3044144800 |
| Fax Number: | 3044144801 |
| NPI Enumeration Date: | 08/22/2014 |
| NPI Last Update Date: | 11/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APRN76097NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |