Provider Demographics
NPI:1881795573
Name:WAHL, MARGARET MARY (RN,)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:WAHL
Suffix:
Gender:F
Credentials:RN,
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:VEZZUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2441
Mailing Address - Country:US
Mailing Address - Phone:707-651-3976
Mailing Address - Fax:707-651-2084
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-3976
Practice Address - Fax:707-651-2084
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276625363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology