Provider Demographics
NPI:1447337100
Name:NELKEN, MARTHA LOUISE (RN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LOUISE
Last Name:NELKEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 GRAND AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-473-2560
Mailing Address - Fax:415-473-4018
Practice Address - Street 1:3260 KERNER BLVD.
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-473-2560
Practice Address - Fax:415-473-4018
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254100163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory