Healthcare Provider Details

I. General information

NPI: 1114128014
Provider Name (Legal Business Name): MARILYN ELIZATBETH MCENHILL RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE ROOM U585
SAN FRANCISCO CA
94143-2208
US

IV. Provider business mailing address

1825 4TH ST FL 6
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2423
  • Fax: 415-476-9976
Mailing address:
  • Phone: 415-502-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number406620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: