Healthcare Provider Details

I. General information

NPI: 1255656872
Provider Name (Legal Business Name): PAMELA ANNE AXELSON RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GROVE ST RM 102
SAN FRANCISCO CA
94102-4505
US

IV. Provider business mailing address

101 GROVE ST RM 102
SAN FRANCISCO CA
94102-4505
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-2860
  • Fax: 415-554-2619
Mailing address:
  • Phone: 415-554-2860
  • Fax: 415-554-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number491985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: