Provider Demographics
NPI:1114922465
Name:ORLOVA-ZITZER, MARILYN IV (FNP, CRNFA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:ORLOVA-ZITZER
Suffix:IV
Gender:F
Credentials:FNP, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94977-0612
Mailing Address - Country:US
Mailing Address - Phone:415-453-3220
Mailing Address - Fax:415-453-3220
Practice Address - Street 1:14 PRESIDIO CT
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-2066
Practice Address - Country:US
Practice Address - Phone:415-453-3220
Practice Address - Fax:415-453-3220
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0131431OtherBLUE SHIELD
CANP0131430Medicaid
CAZZZ27224ZMedicare ID - Type UnspecifiedMEDICARE
CAP00200187Medicare ID - Type UnspecifiedMEDICARE RAILROAD
CANP0131430Medicaid