Healthcare Provider Details

I. General information

NPI: 1174758817
Provider Name (Legal Business Name): ANNE BOEKELHEIDE RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE BOX 0442
SAN FRANCISCO CA
94143-0442
US

IV. Provider business mailing address

513 PARNASSUS AVE
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9136
  • Fax: 415-476-9513
Mailing address:
  • Phone: 415-476-9136
  • Fax: 415-476-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number287114
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: