Healthcare Provider Details

I. General information

NPI: 1386074599
Provider Name (Legal Business Name): MICHELLE MCGINLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 100
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

PO BOX 368
OLYMPIA WA
98507-0368
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-4211
  • Fax: 360-493-0407
Mailing address:
  • Phone: 360-491-8439
  • Fax: 360-491-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60755420
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00141700
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: