Healthcare Provider Details

I. General information

NPI: 1316635956
Provider Name (Legal Business Name): WENDY ANN MARUSSICH PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 POST ST STE 500
SAN FRANCISCO CA
94108-4908
US

IV. Provider business mailing address

360 POST ST STE 500
SAN FRANCISCO CA
94108-4908
US

V. Phone/Fax

Practice location:
  • Phone: 866-798-9374
  • Fax: 415-964-5419
Mailing address:
  • Phone: 866-798-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95083578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPF95021941
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021941
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number160090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: