Provider Demographics
NPI:1679536916
Name:MARTHALLER-ANDERSEN, TONI M (ARNP)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:MARTHALLER-ANDERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:360-929-4584
Mailing Address - Fax:360-678-3783
Practice Address - Street 1:3455 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253
Practice Address - Country:US
Practice Address - Phone:360-222-3131
Practice Address - Fax:360-678-3783
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006304363LF0000X
WARN00079721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8332215Medicaid
WA1679536916OtherNPI