Provider Demographics
NPI:1588721385
Name:KOKMEYER, MARILOU VENDIOLA (CRNA, MS)
Entity type:Individual
Prefix:
First Name:MARILOU
Middle Name:VENDIOLA
Last Name:KOKMEYER
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:MARILOU
Other - Middle Name:P
Other - Last Name:VENDIOLA KOKMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA, MS
Mailing Address - Street 1:1367 FERREL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2371
Mailing Address - Country:US
Mailing Address - Phone:408-272-1190
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL PARKWAY
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-972-7133
Practice Address - Fax:408-972-7662
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered