Provider Demographics
NPI:1245331222
Name:WALLHAGEN, MARGARET INGRID (RN, GNP, PHD)
Entity type:Individual
Prefix:PROF
First Name:MARGARET
Middle Name:INGRID
Last Name:WALLHAGEN
Suffix:
Gender:F
Credentials:RN, GNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PARK TER
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2945
Mailing Address - Country:US
Mailing Address - Phone:415-383-3440
Mailing Address - Fax:
Practice Address - Street 1:2 KORET WAY
Practice Address - Street 2:N631
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0610
Practice Address - Country:US
Practice Address - Phone:415-476-4965
Practice Address - Fax:415-476-8899
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181577363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16349ZMedicare UPIN