Healthcare Provider Details

I. General information

NPI: 1396742540
Provider Name (Legal Business Name): MARIA P. MAGNUSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 DELAWARE ST PEACEHEALTH WOMEN'S HEALTH PAVILION
LONGVIEW WA
98632-2310
US

IV. Provider business mailing address

1115 SE 164TH AVENUE, DEPT. 358
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2800
  • Fax: 360-414-2803
Mailing address:
  • Phone: 360-414-2800
  • Fax: 360-414-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAP30004093
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN00080812
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30004093
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: