Healthcare Provider Details

I. General information

NPI: 1932932282
Provider Name (Legal Business Name): MADELEINE GRACE OSTERGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HYDE ST STE 100
SAN FRANCISCO CA
94109-5998
US

IV. Provider business mailing address

815 HYDE ST STE 100
SAN FRANCISCO CA
94109-5998
US

V. Phone/Fax

Practice location:
  • Phone: 917-657-0615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: