Healthcare Provider Details

I. General information

NPI: 1609903855
Provider Name (Legal Business Name): KIMBERLY ELLEN CLASH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR #G313
PALO ALTO CA
94304-2203
US

IV. Provider business mailing address

300 PASTEUR DR #G313
PALO ALTO CA
94304-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-279-0991
  • Fax:
Mailing address:
  • Phone: 415-279-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number573759
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP13183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: