Provider Demographics
NPI:1366789638
Name:TONI MARTHALLER-ANDERSEN MSN ARNP
Entity type:Organization
Organization Name:TONI MARTHALLER-ANDERSEN MSN ARNP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTHALLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-222-3131
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-1086
Mailing Address - Country:US
Mailing Address - Phone:360-222-3131
Mailing Address - Fax:360-678-3783
Practice Address - Street 1:3455 OLD COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-222-3131
Practice Address - Fax:360-678-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty