Provider Demographics
NPI:1730244377
Name:PIETERS, MARILYN JANE (FNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JANE
Last Name:PIETERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 RIO RITA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1512
Mailing Address - Country:US
Mailing Address - Phone:805-610-9666
Mailing Address - Fax:
Practice Address - Street 1:CAL POLY STATE UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93407
Practice Address - Country:US
Practice Address - Phone:805-756-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner