Healthcare Provider Details

I. General information

NPI: 1396370607
Provider Name (Legal Business Name): MARIE ANNETTE OHAVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE ANNETTE TWYMAN FNP

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MESQUITE AVE STE 100
LAKE HAVASU CITY AZ
86403-5602
US

IV. Provider business mailing address

1720 MESQUITE AVE STE 100
LAKE HAVASU CITY AZ
86403-5602
US

V. Phone/Fax

Practice location:
  • Phone: 928-412-8088
  • Fax: 928-412-8807
Mailing address:
  • Phone: 928-412-8088
  • Fax: 928-412-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number243646
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number243646
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number243646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: