Provider Demographics
NPI:1245608264
Name:MCINCHAK, MISTY
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:MCINCHAK
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 1:22308 GLENN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8055
Mailing Address - Country:US
Mailing Address - Phone:360-333-1918
Mailing Address - Fax:
Practice Address - Street 1:22308 GLENN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8055
Practice Address - Country:US
Practice Address - Phone:360-333-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60308826164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse