Provider Demographics
NPI:1750044293
Name:BARCLAY, GINA (LPN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BARCLAY
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 1:800 S MERIDIAN STE A&B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6995
Mailing Address - Country:US
Mailing Address - Phone:253-235-5216
Mailing Address - Fax:253-944-1750
Practice Address - Street 1:800 S MERIDIAN STE A&B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-6995
Practice Address - Country:US
Practice Address - Phone:253-235-5216
Practice Address - Fax:253-944-1750
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61204522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse