Healthcare Provider Details

I. General information

NPI: 1235109471
Provider Name (Legal Business Name): MARY ANNE ELIZABETH LANDOWSKI RN00130116
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANNE ELIZABETH LANDOWSKI RN, MSN, CWCN

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDIAL CENTER 9040A FITZSIMMONS AVE; C/O VASCULAR CLINIC
TACOMA WA
98431-0001
US

IV. Provider business mailing address

29217 25TH AVE S
ROY WA
98580-7703
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2357
  • Fax: 253-968-5997
Mailing address:
  • Phone: 253-968-2357
  • Fax: 253-968-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN00130116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: