=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972517118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER R. NATHANSON MSN, NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DANIEL BURNHAM CT STE 205C
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-221-7056
-----------------------------------------------------
Fax | 415-221-7058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DANIEL BURNHAM CT STE 205C
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-221-7056
-----------------------------------------------------
Fax | 415-221-7058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 536405
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------