Healthcare Provider Details

I. General information

NPI: 1245655869
Provider Name (Legal Business Name): NATHANIEL D BOHN MS, RN, CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

1260 MINNESOTA ST UNIT 205
SAN FRANCISCO CA
94107-3669
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1352
  • Fax:
Mailing address:
  • Phone: 513-407-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAC001317
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95010827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: