Healthcare Provider Details

I. General information

NPI: 1679536916
Provider Name (Legal Business Name): TONI M MARTHALLER-ANDERSEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI M MARTIN

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD COUNTY RD
GREENBANK WA
98253
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: 360-929-4584
  • 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
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN00079721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: