Healthcare Provider Details

I. General information

NPI: 1649845413
Provider Name (Legal Business Name): BRIGITTE ANN CLARY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-0001
US

IV. Provider business mailing address

123 S UNION RD
ELMA WA
98541-9434
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1720
  • Fax: 253-968-5295
Mailing address:
  • Phone: 910-391-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61022260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: