=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124437744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE REGISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2014
-----------------------------------------------------
Last Update Date | 03/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 UNIVERSITY AVE STE 260
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-1664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-462-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 BRYANT ST # 373
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MRS. MELISSA FISCHER
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 650-462-1001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------