1235109471 NPI number — MS. MARY ANNE ELIZABETH LANDOWSKI RN00130116

Table of content: MS. MARY ANNE ELIZABETH LANDOWSKI RN00130116 (NPI 1235109471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235109471 NPI number — MS. MARY ANNE ELIZABETH LANDOWSKI RN00130116

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDOWSKI
Provider First Name:
MARY ANNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN00130116
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANDOWSKI
Provider Other First Name:
MARY ANNE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MSN, CWCN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235109471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29217 25TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98580-7703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-2357
Provider Business Mailing Address Fax Number:
253-968-5997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MADIGAN ARMY MEDIAL CENTER
Provider Second Line Business Practice Location Address:
9040A FITZSIMMONS AVE; C/O VASCULAR CLINIC
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-2357
Provider Business Practice Location Address Fax Number:
253-968-5997
Provider Enumeration Date:
01/23/2006

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: 163WW0000X , with the licence number:  RN00130116 , 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)