Provider Demographics
NPI:1164700258
Name:DAHMER, MARIAN ELLEN (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:ELLEN
Last Name:DAHMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HAWTHORNE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:510-452-1102
Practice Address - Street 1:365 HAWTHORNE AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3114
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant