Provider Demographics
NPI:1841464401
Name:CORREA, ANNEMARIE (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANNEMARIE
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:ANNEMARIE
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:21 NE ROMANCE HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-8315
Mailing Address - Country:US
Mailing Address - Phone:360-277-2950
Mailing Address - Fax:360-277-2980
Practice Address - Street 1:21 NE ROMANCE HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8315
Practice Address - Country:US
Practice Address - Phone:360-277-2950
Practice Address - Fax:360-277-2980
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60031042363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092963Medicaid