MEDICARE: MARIKO HOLLAND NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	22133	CA

General Provider Information

NPI Number	:	1922468479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIKO HOLLAND NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	141 RAFAEL DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2271
Country	:	US
Telephone Number	:	510-301-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 RAFAEL DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2271
Country	:	US
Telephone Number	:	510-301-9396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	02/26/2016

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