Healthcare Provider Details

I. General information

NPI: 1952060899
Provider Name (Legal Business Name): LAURA KATHRYN CICCHETTI CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 BUSH ST
SAN FRANCISCO CA
94109-5420
US

IV. Provider business mailing address

678 WALLER ST
SAN FRANCISCO CA
94117-3321
US

V. Phone/Fax

Practice location:
  • Phone: 415-821-1282
  • Fax:
Mailing address:
  • Phone: 401-524-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95017519
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW236194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: