Healthcare Provider Details

I. General information

NPI: 1801035043
Provider Name (Legal Business Name): MARCIA TUMY BYRNES RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RITTER ST
SAN RAFAEL CA
94901-3323
US

IV. Provider business mailing address

129 BIRCH WAY
SAN RAFAEL CA
94903-2942
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-8182
  • Fax: 415-457-3490
Mailing address:
  • Phone: 415-847-5300
  • Fax: 415-472-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number236717
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number19099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: