Healthcare Provider Details

I. General information

NPI: 1144975673
Provider Name (Legal Business Name): MARLENE MILLER MUIR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 16TH ST STE 310
OAKLAND CA
94612-1284
US

IV. Provider business mailing address

3047 SOMBRERO CIR
SAN RAMON CA
94583-2211
US

V. Phone/Fax

Practice location:
  • Phone: 210-780-4544
  • Fax:
Mailing address:
  • Phone: 925-785-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number4113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: