Provider Demographics
NPI:1932814696
Name:VAN HORN, MARGEAUX LYNN
Entity type:Individual
Prefix:
First Name:MARGEAUX
Middle Name:LYNN
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGEAUX
Other - Middle Name:LYNN
Other - Last Name:MARQUISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 DANIELLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3127
Mailing Address - Country:US
Mailing Address - Phone:805-698-5090
Mailing Address - Fax:
Practice Address - Street 1:2425 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-833-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95038231163W00000X
CA4633364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse