MEDICARE: DIANNE GRACE GEORGETTI NP

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	363LG0600X	Gerontology Nurse Practitioner	95022480	CA
2	163WC0400X	Case Management Registered Nurse	706152	CA

General Provider Information

NPI Number	:	1306547757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE GRACE GEORGETTI NP

Provider Business Mailing Address
First Line	:	350 PARNASSUS AVE STE 908
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-3612
Country	:	US
Telephone Number	:	415-353-2119
Fax Number	:	415-353-2406

Provider Business Practice Location Address
First Line	:	350 PARNASSUS AVE STE 908
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-3612
Country	:	US
Telephone Number	:	415-353-2119
Fax Number	:	415-353-2406

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

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	10/14/2024

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