Healthcare Provider Details

I. General information

NPI: 1881370385
Provider Name (Legal Business Name): JULIE MCCLURG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

6019 COUGAR DR
KNOXVILLE TN
37921-3902
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN61433578
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP61499407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: