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General NPI Number Information
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NPI Number | 1780954503
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Entity Type | Individual
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Provider Name | ELISSA HALLEN RN, CDE
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Gender | Female
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 3555 CESAR CHAVEZ DIABETES CENTER ROOM 230
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4403
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Country | US
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Telephone | 415-533-9293
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Fax | 415-641-6829
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Provider Business Mailing Address
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Address Line | 229 CRAUT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-1503
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Country | US
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Telephone | 415-533-9293
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Fax | 415-641-6829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 422033
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License Number State | CA
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