Healthcare Provider Details

I. General information

NPI: 1134525512
Provider Name (Legal Business Name): JANE LEE NP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE 10 ICC & 10 CVT
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

500 PARNASSUS AVE MILLBERRY UNION WEST, MU-405, BOX 0118
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1606
  • Fax:
Mailing address:
  • Phone: 415-353-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95001627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95001627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: