Healthcare Provider Details

I. General information

NPI: 1790399574
Provider Name (Legal Business Name): WESTON WYNNE ERNST NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE M-917
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1007
  • Fax:
Mailing address:
  • Phone: 415-353-1116
  • Fax: 415-353-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95015311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: