MEDICARE: MARY GERMAINE D'ANNIBALLE ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30003636	WA

General Provider Information

NPI Number	:	1073542411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GERMAINE D'ANNIBALLE ARNP

Provider Business Mailing Address
First Line	:	2719 E MADISON ST
Second Line	:	SUITE 301
City	:	SEATTLE
State	:	WA
Zip	:	98112-4752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 E MADISON ST
Second Line	:	SUITE 301
City	:	SEATTLE
State	:	WA
Zip	:	98112-4752
Country	:	US
Telephone Number	:	206-390-7186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/24/2007

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