Individual
JOSEPH MCILVAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1060 W PERIMETER RD STE 3K43, JB ANDREWS, MD 20762-6602
(888) 999-1212
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871097717
—
NV
Enumeration date
03/23/2018
Last updated
04/25/2025
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