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General NPI Number Information
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NPI Number | 1275387532
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC NURSING PRESCRIBER
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Dates
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Enumeration Date | 04/15/2024
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 1 SANSOME ST FL 35
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-4436
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Country | US
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Telephone | 415-605-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 836 SOUTHAMPTON ROAD STE B #115
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City | BENICIA
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State | CA
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Zip | 94510
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Country | US
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Telephone | 415-605-5760
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | REBECCA BLAKESLEY
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Credential | PMHNP
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Telephone | 415-605-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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