Provider Demographics
NPI:1396742540
Name:MAGNUSON, MARIA P (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:P
Last Name:MAGNUSON
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 1:1115 SE 164TH AVENUE, DEPT. 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-414-2800
Mailing Address - Fax:360-414-2803
Practice Address - Street 1:1660 DELAWARE ST
Practice Address - Street 2:PEACEHEALTH WOMEN'S HEALTH PAVILION
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2800
Practice Address - Fax:360-414-2803
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004093174400000X, 363LX0001X
WARN00080812363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657432Medicaid
WA7002645Medicaid
S26623Medicare UPIN
WA7002645Medicaid