Provider Demographics
NPI:1003533050
Name:MCGRAW, MARCELLE DURRETTE (LPN)
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:DURRETTE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16317 44TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-5913
Mailing Address - Country:US
Mailing Address - Phone:253-297-2689
Mailing Address - Fax:
Practice Address - Street 1:1750 BOBS HOLLOW LN
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-6709
Practice Address - Country:US
Practice Address - Phone:253-583-7208
Practice Address - Fax:253-583-7292
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00037021164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse