Provider Demographics
NPI:1144975673
Name:MUIR, MARLENE MILLER (NP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MILLER
Last Name:MUIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 SOMBRERO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2211
Mailing Address - Country:US
Mailing Address - Phone:925-785-3606
Mailing Address - Fax:
Practice Address - Street 1:610 16TH ST STE 310
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1284
Practice Address - Country:US
Practice Address - Phone:210-780-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4113363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty