Provider Demographics
NPI:1972114650
Name:MARKMAN, GREGORY JAMES (RN)
Entity Type:Individual
Prefix:MS
First Name:GREGORY
Middle Name:JAMES
Last Name:MARKMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 TRAFALGAR PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3245
Mailing Address - Country:US
Mailing Address - Phone:539-219-8826
Mailing Address - Fax:
Practice Address - Street 1:2181 TRAFALGAR PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-3245
Practice Address - Country:US
Practice Address - Phone:539-219-8826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95119575163WC0200X
CA95002033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine