Provider Demographics
NPI:1598861080
Name:GOLDEN, MARY JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 THIRD AVE 610
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1160
Mailing Address - Country:US
Mailing Address - Phone:206-622-6962
Mailing Address - Fax:
Practice Address - Street 1:1904 THIRD AVE 610
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1160
Practice Address - Country:US
Practice Address - Phone:206-622-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003802364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult