Healthcare Provider Details

I. General information

NPI: 1942536131
Provider Name (Legal Business Name): BERNADETTE DONOVAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 08/18/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-3823
US

IV. Provider business mailing address

PO BOX 26170
SAN FRANCISCO CA
94126-6170
US

V. Phone/Fax

Practice location:
  • Phone: 415-578-3100
  • Fax: 415-354-3430
Mailing address:
  • Phone: 415-814-0927
  • Fax: 415-354-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number19046
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: