Provider Demographics
NPI:1891034328
Name:HANLAN, MARGO ELIZABETH (PNP)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:ELIZABETH
Last Name:HANLAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BON AIR ROAD
Mailing Address - Street 2:STE. 105
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939
Mailing Address - Country:US
Mailing Address - Phone:415-461-0440
Mailing Address - Fax:415-461-3792
Practice Address - Street 1:5 BON AIR ROAD
Practice Address - Street 2:STE. 105
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939
Practice Address - Country:US
Practice Address - Phone:415-461-0440
Practice Address - Fax:415-461-3792
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170555363L00000X
CA95002831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner