Healthcare Provider Details

I. General information

NPI: 1164684924
Provider Name (Legal Business Name): ROSEMARY JUDITH OLIVE RN, MSN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 BRYCE CANYON RD
SAN RAFAEL CA
94903-2226
US

IV. Provider business mailing address

PO BOX 6695
SAN RAFAEL CA
94903-0695
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-7682
  • Fax:
Mailing address:
  • Phone: 415-499-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number1972
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP1700X
TaxonomyPerinatal Clinical Nurse Specialist
License Number1972
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 338797
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberCNS 1972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: