Provider Demographics
NPI:1629351317
Name:KOOMEN, ANNE ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:KOOMEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:WARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R N
Mailing Address - Street 1:834 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2443
Mailing Address - Country:US
Mailing Address - Phone:360-385-2200
Mailing Address - Fax:
Practice Address - Street 1:915 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2931
Practice Address - Country:US
Practice Address - Phone:360-385-4848
Practice Address - Fax:360-379-4383
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA778674163W00000X, 390200000X
WAAP60298613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health