Provider Demographics
NPI:1922468479
Name:HOLLAND, MARIKO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 RAFAEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2271
Mailing Address - Country:US
Mailing Address - Phone:510-301-9396
Mailing Address - Fax:
Practice Address - Street 1:141 RAFAEL DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2271
Practice Address - Country:US
Practice Address - Phone:510-301-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22133363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics