Healthcare Provider Details

I. General information

NPI: 1992058655
Provider Name (Legal Business Name): JESSICA MASON LEVIN CNM, RN, L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MASON L.AC., LMT

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1782 36TH AVE
SAN FRANCISCO CA
94122-4115
US

V. Phone/Fax

Practice location:
  • Phone: 503-867-1753
  • Fax: 503-867-1753
Mailing address:
  • Phone: 503-867-1753
  • Fax: 503-867-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95171339
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC159731
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10676
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW235995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: