Healthcare Provider Details

I. General information

NPI: 1609057199
Provider Name (Legal Business Name): SARAH JANE MCCUSKEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PHELAN AVE HC 100
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

50 PHELAN AVE HC 100
SAN FRANCISCO CA
94112-1821
US

V. Phone/Fax

Practice location:
  • Phone: 415-241-2229
  • Fax: 415-239-3193
Mailing address:
  • Phone: 415-241-2229
  • Fax: 415-239-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number191506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: