1396742540 NPI number — MS. MARIA P. MAGNUSON ARNP

Table of content: (NPI 1023005386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396742540 NPI number — MS. MARIA P. MAGNUSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGNUSON
Provider First Name:
MARIA
Provider Middle Name:
P.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396742540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 SE 164TH AVENUE, DEPT. 358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-414-2800
Provider Business Mailing Address Fax Number:
360-414-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 DELAWARE ST
Provider Second Line Business Practice Location Address:
PEACEHEALTH WOMEN'S HEALTH PAVILION
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-414-2800
Provider Business Practice Location Address Fax Number:
360-414-2803
Provider Enumeration Date:
07/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  AP30004093 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: RN00080812 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: AP30004093 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500657432 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7002645 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".