Provider Demographics
NPI:1972517118
Name:NATHANSON, JENNIFER R (MSN, NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:NATHANSON
Suffix:
Gender:
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT STE 205C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5472
Mailing Address - Country:US
Mailing Address - Phone:415-221-7056
Mailing Address - Fax:415-221-7058
Practice Address - Street 1:1 DANIEL BURNHAM CT STE 205C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5472
Practice Address - Country:US
Practice Address - Phone:415-221-7056
Practice Address - Fax:415-221-7058
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA005364050Medicaid
CA005364050Medicare PIN