Healthcare Provider Details

I. General information

NPI: 1124495247
Provider Name (Legal Business Name): MICHELE CRONIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

IV. Provider business mailing address

601 VAN NESS AVE STE E3619
SAN FRANCISCO CA
94102-3200
US

V. Phone/Fax

Practice location:
  • Phone: 415-334-2500
  • Fax:
Mailing address:
  • Phone: 415-531-9047
  • Fax: 415-213-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: