Healthcare Provider Details

I. General information

NPI: 1043470271
Provider Name (Legal Business Name): DANIELA WOTKE RN, PHN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CAPP ST
SAN FRANCISCO CA
94110-1210
US

IV. Provider business mailing address

160 CAPP ST
SAN FRANCISCO CA
94110-1210
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number683389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: