MEDICARE: NIKKA MARIE ELMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1821282153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKA MARIE ELMAN

Provider Business Mailing Address
First Line	:	288 GUTTENBERG ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-4346
Country	:	US
Telephone Number	:	415-794-3989
Fax Number	:

Provider Business Practice Location Address
First Line	:	4527 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2603
Country	:	US
Telephone Number	:	415-337-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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