Healthcare Provider Details

I. General information

NPI: 1073693362
Provider Name (Legal Business Name): SUNNY ELIZABETH ST. GERMAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 KERNER BLVD
SAN RAFAEL CA
94901-4840
US

IV. Provider business mailing address

8645 SE SUNNYBROOK BLVD STE 200
CLACKAMAS OR
97015-6841
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1536
  • Fax: 415-461-7334
Mailing address:
  • Phone: 503-659-1694
  • Fax: 503-659-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201810581NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP15105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: