Healthcare Provider Details

I. General information

NPI: 1144790957
Provider Name (Legal Business Name): TERRY LEE MCINERNEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

IV. Provider business mailing address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

V. Phone/Fax

Practice location:
  • Phone: 206-933-7050
  • Fax:
Mailing address:
  • Phone: 206-933-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN00117551
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00117551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: