Provider Demographics
NPI:1518063536
Name:TODD, MARY ANNETTE (FNP, ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNETTE
Last Name:TODD
Suffix:
Gender:F
Credentials:FNP, ARNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ANNETTE
Other - Last Name:VAN HOLDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24701 NE 228TH CIR
Mailing Address - Street 2:PO BOX 968
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9641
Mailing Address - Country:US
Mailing Address - Phone:360-687-0317
Mailing Address - Fax:360-687-7935
Practice Address - Street 1:1230 7TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3166
Practice Address - Country:US
Practice Address - Phone:360-575-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA AP30007209363LF0000X
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily