Healthcare Provider Details

I. General information

NPI: 1255586293
Provider Name (Legal Business Name): JANE IVORY PETRIE RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANE IVORY ERNSTTHAL

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FRIDA KAHLO WAY
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

50 FRIDA KAHLO WAY HC-100
SAN FRANCISCO CA
94112
US

V. Phone/Fax

Practice location:
  • Phone: 415-239-3110
  • Fax: 415-239-3193
Mailing address:
  • Phone: 415-239-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number651984
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: