Healthcare Provider Details

I. General information

NPI: 1376609156
Provider Name (Legal Business Name): LORI J. MCCLINTOCK C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LILLY RD NE
OLYMPIA WA
98506-5115
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 360-923-7000
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00112335
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP30003982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: