Basic Information
| Provider Information | |||||||||
| NPI: | 1487164539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENDAHL | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | MICHAELA | ||||||||
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| Credential: | RN, C-PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 GOLDEN HIND PSGE | ||||||||
| Address2: | |||||||||
| City: | CORTE MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949251907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156868237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22331 MISSION BLVD | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945413911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2017 | ||||||||
| LastUpdateDate: | 10/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95068257 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 95007117 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.