MEDICARE: ELIZABETH PAPP-VANCELLETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0002X	Neonatal Intensive Care Registered Nurse	720766	CA
2	363LF0000X	Family Nurse Practitioner	22287	CA
3	364S00000X	Clinical Nurse Specialist	4746	CA

General Provider Information

NPI Number	:	1174486377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PAPP-VANCELLETTE

Provider Business Mailing Address
First Line	:	2434 32ND AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 4TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2351
Country	:	US
Telephone Number	:	415-353-8847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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