Provider Demographics
NPI:1295165405
Name:KRISTENSEN, MARIE A (NURSE PRACTICIONER)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:KRISTENSEN
Suffix:
Gender:F
Credentials:NURSE PRACTICIONER
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6100 REDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4501
Mailing Address - Country:US
Mailing Address - Phone:415-448-1500
Mailing Address - Fax:
Practice Address - Street 1:6100 REDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4501
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00556885Medicaid