Provider Demographics
NPI:1760571574
Name:GODFREY, MARYANNE ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:ELIZABETH
Last Name:GODFREY
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 1:1728 W MARINE VIEW DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2094
Mailing Address - Country:US
Mailing Address - Phone:425-252-9216
Mailing Address - Fax:425-252-8637
Practice Address - Street 1:1728 W MARINE VIEW DR
Practice Address - Street 2:SUITE 109
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:425-252-9216
Practice Address - Fax:425-252-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001509363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8805439Medicare ID - Type Unspecified