Basic Information
| Provider Information | |||||||||
| NPI: | 1396742540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGNUSON | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVENUE, DEPT. 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142800 | ||||||||
| FaxNumber: | 3604142803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 DELAWARE ST | ||||||||
| Address2: | PEACEHEALTH WOMEN'S HEALTH PAVILION | ||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142800 | ||||||||
| FaxNumber: | 3604142803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 08/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AP30004093 | WA | N | Other Service Providers | Specialist | 363LW0102X | RN00080812 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LX0001X | AP30004093 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 500657432 | 05 | OR | MEDICAID | 7002645 | 05 | WA | MEDICAID |