Healthcare Provider Details

I. General information

NPI: 1295120855
Provider Name (Legal Business Name): AUBREY RUSSELL-SWETEK CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST 6TH FLOOR
SAN FRANCISCO CA
94158-2350
US

IV. Provider business mailing address

550 16TH ST 4TH FLOOR, BOX 0434
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-0238
  • Fax:
Mailing address:
  • Phone: 415-514-0238
  • Fax: 415-353-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: