Provider Demographics
NPI:1396370607
Name:OHAVER, MARIE ANNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANNETTE
Last Name:OHAVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANNETTE
Other - Last Name:TWYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1720 MESQUITE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5602
Mailing Address - Country:US
Mailing Address - Phone:928-412-8088
Mailing Address - Fax:928-412-8807
Practice Address - Street 1:1720 MESQUITE AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5602
Practice Address - Country:US
Practice Address - Phone:928-412-8088
Practice Address - Fax:928-412-8807
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243646207Q00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care