Provider Demographics
NPI:1033223755
Name:BURGESS, MARNE ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:MARNE
Middle Name:ANNE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARNE
Other - Middle Name:ANNE
Other - Last Name:SARRIA BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:10 N SAN PEDRO RD
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4178
Mailing Address - Country:US
Mailing Address - Phone:415-473-4306
Mailing Address - Fax:415-473-4307
Practice Address - Street 1:10 N SAN PEDRO RD
Practice Address - Street 2:SUITE 1020
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4178
Practice Address - Country:US
Practice Address - Phone:415-473-4306
Practice Address - Fax:415-473-4307
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner