Healthcare Provider Details

I. General information

NPI: 1932814696
Provider Name (Legal Business Name): MARGEAUX LYNN VAN HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGEAUX LYNN MARQUISS

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

127 DANIELLE DR
SAN RAFAEL CA
94903-3127
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-3304
  • Fax:
Mailing address:
  • Phone: 805-698-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95038231
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: