Provider Demographics
NPI:1992871107
Name:FUSFIELD, MARA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LYNN
Last Name:FUSFIELD
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 1581
Mailing Address - Street 2:
Mailing Address - City:MATTAWA
Mailing Address - State:WA
Mailing Address - Zip Code:99349-0960
Mailing Address - Country:US
Mailing Address - Phone:509-932-4499
Mailing Address - Fax:509-932-5363
Practice Address - Street 1:210 GOVERNMENT RD
Practice Address - Street 2:
Practice Address - City:MATTAWA
Practice Address - State:WA
Practice Address - Zip Code:99349-5116
Practice Address - Country:US
Practice Address - Phone:509-932-4499
Practice Address - Fax:509-932-5363
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005706363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0399341Other(L&I)
WA1024069Medicaid
WAP00601285OtherRAILROAD MEDICARE
WA0233206OtherL&I
WAAB38059Medicare Oscar/Certification