Healthcare Provider Details

I. General information

NPI: 1720374408
Provider Name (Legal Business Name): ALEXANDRA MARY MCLAUGHRY MVB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 NE 112TH AVE
VANCOUVER WA
98684-5018
US

IV. Provider business mailing address

4540 SW CAMERON RD
PORTLAND OR
97221-2918
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-0032
  • Fax:
Mailing address:
  • Phone: 360-835-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT00007420
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6742
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: