=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710205158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FATIMA ASCANO-MARTIN DNP, RN, GCNS-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2010
-----------------------------------------------------
Last Update Date | 01/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 LAGUNA HONDA BLVD
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-759-4017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 375 LAGUNA HONDA BLVD
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-759-4017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN 467281
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------