Healthcare Provider Details

I. General information

NPI: 1912261389
Provider Name (Legal Business Name): JEANETTE MARIE BROERING RN, PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE MARIE BROERING-HOOKER RN

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST GERIATRICS, PALLIATIVE, AND EXTENDED CARE
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-750-6641
Mailing address:
  • Phone: 415-221-4810
  • Fax: 415-750-6641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number360193
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1621
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number360193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: