Healthcare Provider Details

I. General information

NPI: 1033921200
Provider Name (Legal Business Name): KATHLEEN VIRGINIA MACKERROW MS, RN, CNS, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 LAGUNA HONDA BLVD OFC A412
SAN FRANCISCO CA
94116-1411
US

IV. Provider business mailing address

139 HUGO ST APT 9
SAN FRANCISCO CA
94122-2761
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-3066
  • Fax:
Mailing address:
  • Phone: 415-215-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number457518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number1253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: