Healthcare Provider Details

I. General information

NPI: 1104509355
Provider Name (Legal Business Name): PRONURSEREGISTERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 ALMADEN RD
SAN JOSE CA
95125-1971
US

IV. Provider business mailing address

1785 ALMADEN RD
SAN JOSE CA
95125-1971
US

V. Phone/Fax

Practice location:
  • Phone: 408-832-7165
  • Fax:
Mailing address:
  • Phone: 408-832-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: HANA ABOYE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 408-832-7165