Healthcare Provider Details

I. General information

NPI: 1871777920
Provider Name (Legal Business Name): LOIS ANNE INDORF NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST STREET SUITE 260
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

2330 POST STREET SUITE 260
SAN FRANCISCO CA
94143-1799
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-3606
  • Fax: 415-885-7678
Mailing address:
  • Phone: 415-885-3606
  • Fax: 415-885-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: