Healthcare Provider Details

I. General information

NPI: 1164148342
Provider Name (Legal Business Name): COURTNEY NICOLE MCGUIRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 N PEARL ST
TACOMA WA
98406-2457
US

IV. Provider business mailing address

3518 S AINSWORTH AVE
TACOMA WA
98418-2623
US

V. Phone/Fax

Practice location:
  • Phone: 253-879-0140
  • Fax:
Mailing address:
  • Phone: 253-208-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN60295267
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: