Provider Demographics
NPI:1366619140
Name:BIRD, LOUISE JACKSON (RN)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:JACKSON
Last Name:BIRD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2217
Mailing Address - Country:US
Mailing Address - Phone:215-939-8153
Mailing Address - Fax:
Practice Address - Street 1:245 11TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3732
Practice Address - Country:US
Practice Address - Phone:415-355-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694801163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management