Healthcare Provider Details

I. General information

NPI: 1891832358
Provider Name (Legal Business Name): BETHANY JOYCE PHOENIX RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 18TH ST STE. 202
SAN FRANCISCO CA
94110-2043
US

IV. Provider business mailing address

2 KORET WAY, DEPT. OF COMMUNITY HEALTH SYSTEMS UCSF BOX 0608
SAN FRANCISCO CA
94143-0608
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5777
  • Fax: 415-502-5764
Mailing address:
  • Phone: 415-502-4407
  • Fax: 415-476-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number331209
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: