Healthcare Provider Details

I. General information

NPI: 1235153123
Provider Name (Legal Business Name): JENNIFER REI KANENAGA RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE FAMILY HEALTH CENTER, WARD 83
SAN FRANCISCO CA
94110-2859
US

IV. Provider business mailing address

995 POTRERO AVE FAMILY HEALTH CENTER, WARD 83
SAN FRANCISCO CA
94110-2859
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8610
  • Fax: 415-206-8387
Mailing address:
  • Phone: 415-206-8610
  • Fax: 415-206-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number557998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: