Provider Demographics
NPI:1619526647
Name:MCLAIN, TRYNA MARIE
Entity Type:Individual
Prefix:
First Name:TRYNA
Middle Name:MARIE
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9302
Mailing Address - Country:US
Mailing Address - Phone:509-987-1778
Mailing Address - Fax:509-783-5995
Practice Address - Street 1:4803 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9302
Practice Address - Country:US
Practice Address - Phone:509-987-1778
Practice Address - Fax:509-783-5995
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00172137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse