Healthcare Provider Details

I. General information

NPI: 1285295071
Provider Name (Legal Business Name): JOSEPH MCCLAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

IV. Provider business mailing address

9930 EVERGREEN WAY BLDG Z
EVERETT WA
98204-3883
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-5121
  • Fax:
Mailing address:
  • Phone: 425-347-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60958937
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: