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NPI Code Detail

MEDICARE: MS. KATHLEEN CLANCY RN/NP

MEDICARE: MS. KATHLEEN CLANCY RN/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
1363LA2200XAdult Health Nurse Practitioner189760CA

General Provider Information

NPI Number : 1497737977
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN CLANCY RN/NP
Provider Business Mailing Address
First Line : 3728 CANYON WAY
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-3714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 MUIR RD
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-4668
Country : US
Telephone Number : 925-372-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 07/08/2007

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