Healthcare Provider Details

I. General information

NPI: 1295100931
Provider Name (Legal Business Name): ANNIE LI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST STE 380
SAN FRANCISCO CA
94158-2335
US

IV. Provider business mailing address

1500 OWENS ST STE 380
SAN FRANCISCO CA
94158-2335
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7788
  • Fax:
Mailing address:
  • Phone: 415-885-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP129125
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: