Provider Demographics
NPI:1912261389
Name:BROERING, JEANETTE MARIE (RN, PHD, MPH)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:BROERING
Suffix:
Gender:F
Credentials:RN, PHD, MPH
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:BROERING-HOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-750-6641
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:GERIATRICS, PALLIATIVE, AND EXTENDED CARE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-6641
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360193163W00000X, 390200000X
CA1621363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics