Healthcare Provider Details

I. General information

NPI: 1417578550
Provider Name (Legal Business Name): ANNA S MICKELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA SIERRA WILCOXON

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

490 ILLINOIS ST
SAN FRANCISCO CA
94143-2510
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015329
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP95015329
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95136715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: