Healthcare Provider Details

I. General information

NPI: 1598861080
Provider Name (Legal Business Name): MARY JANE GOLDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 THIRD AVE 610
SEATTLE WA
98101-1160
US

IV. Provider business mailing address

1904 THIRD AVE 610
SEATTLE WA
98101-1160
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-6962
  • Fax:
Mailing address:
  • Phone: 206-622-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30003802
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: