Provider Demographics
NPI:1033245014
Name:NILSON, MARJORIE WASEM (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:WASEM
Last Name:NILSON
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 1:131 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1344
Mailing Address - Country:US
Mailing Address - Phone:805-893-3087
Mailing Address - Fax:805-893-4911
Practice Address - Street 1:STUDENT HEALTH SERVICE
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, SANTA BARBARA
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-0001
Practice Address - Country:US
Practice Address - Phone:805-893-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD265234, FP2917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner