Healthcare Provider Details

I. General information

NPI: 1366789638
Provider Name (Legal Business Name): TONI MARTHALLER-ANDERSEN MSN ARNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD COUNTY ROAD
GREENBANK WA
98249
US

IV. Provider business mailing address

PO BOX 1086
FREELAND WA
98249-1086
US

V. Phone/Fax

Practice location:
  • Phone: 360-222-3131
  • Fax: 360-678-3783
Mailing address:
  • Phone: 360-222-3131
  • Fax: 360-678-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006304
License Number StateWA

VIII. Authorized Official

Name: TONI M MARTHALLER
Title or Position: OWNER
Credential: ARNP
Phone: 360-222-3131