Healthcare Provider Details

I. General information

NPI: 1487496253
Provider Name (Legal Business Name): NICOLE MARIE BUSSE SCHUHMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 DORE ST
SAN FRANCISCO CA
94103-3828
US

IV. Provider business mailing address

368 FELL ST
SAN FRANCISCO CA
94102-5144
US

V. Phone/Fax

Practice location:
  • Phone: 415-861-0828
  • Fax:
Mailing address:
  • Phone: 415-861-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95140986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: