Provider Demographics
NPI:1639935497
Name:MCCLURE, BRAELYN JOY
Entity Type:Individual
Prefix:
First Name:BRAELYN
Middle Name:JOY
Last Name:MCCLURE
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 1:8531 BENSON RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9711
Mailing Address - Country:US
Mailing Address - Phone:360-223-2243
Mailing Address - Fax:
Practice Address - Street 1:8531 BENSON RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9711
Practice Address - Country:US
Practice Address - Phone:360-223-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program