Healthcare Provider Details

I. General information

NPI: 1356966576
Provider Name (Legal Business Name): KENDRA NELSON-RURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 LINCOLN WAY
SAN FRANCISCO CA
94122-2210
US

IV. Provider business mailing address

921 LINCOLN WAY
SAN FRANCISCO CA
94122-2210
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-1414
  • Fax: 415-664-7741
Mailing address:
  • Phone: 415-664-1414
  • Fax: 415-664-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: