Provider Demographics
NPI:1801124136
Name:THURMOND, MARILYNN R (LVN)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:R
Last Name:THURMOND
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 BUSCA DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-7754
Mailing Address - Country:US
Mailing Address - Phone:510-553-8500
Mailing Address - Fax:510-553-8550
Practice Address - Street 1:7200 BANCROFT AVE BLDG B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:510-553-8550
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN153576164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse