Basic Information
| Provider Information | |||||||||
| NPI: | 1356820997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | JULIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 YAKIMA AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535521200 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1708 YAKIMA AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535521200 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.PA.60867603 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA60867603 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2112552 | 05 | WA | MEDICAID |