Provider Demographics
NPI:1386978542
Name:MAAGDENBERG, ANNA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:MAAGDENBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 UNION ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3635
Practice Address - Country:US
Practice Address - Phone:650-636-1286
Practice Address - Fax:650-588-4164
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25706363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ96273ZOtherGROUP MEDICARE PIN RENDERING UNDER
CAG25706OtherCA RN/LP LISCENCE
CAZZZ16577ZMedicare PIN