Healthcare Provider Details

I. General information

NPI: 1447337100
Provider Name (Legal Business Name): MARTHA LOUISE NELKEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 KERNER BLVD.
SAN RAFAEL CA
94901
US

IV. Provider business mailing address

1675 GRAND AVE.
SAN RAFAEL CA
94901
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-2560
  • Fax: 415-473-4018
Mailing address:
  • Phone: 415-473-2560
  • Fax: 415-473-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number254100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: