Healthcare Provider Details

I. General information

NPI: 1942380738
Provider Name (Legal Business Name): JESSICA PURDY AXELROD P.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA FRANKLIN PURDY PNP

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

259 WEBSTER ST
PALO ALTO CA
94301-1236
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-3612
  • Fax:
Mailing address:
  • Phone: 650-384-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: