Provider Demographics
NPI:1245257054
Name:FAILONI, ANN M (ARNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:FAILONI
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:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:661 NESS CORNER RD
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339
Practice Address - Country:US
Practice Address - Phone:360-912-5777
Practice Address - Fax:206-472-6035
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005953363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA423898079OtherGROUP HEALTH COOPERATIVE
WA8937956OtherL & I (CRIME VICTIM)
WA3976FAOtherREGENCE BLUESHIELD
WA9635301Medicaid
WA0202595OtherL & I (REGULAR)
WA192942504OtherUS DEPT OF LABOR
WAP00272186OtherRAILROAD MEDICARE
WA0202595OtherL & I (REGULAR)
WA9635301Medicaid