Healthcare Provider Details

I. General information

NPI: 1124426309
Provider Name (Legal Business Name): MRS. MARIEKE VAN NUENEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

2620 MCALLISTER ST APT B
SAN FRANCISCO CA
94118-4113
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-4444
  • Fax: 628-206-3142
Mailing address:
  • Phone: 404-680-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: