Provider Demographics
NPI:1992809115
Name:PLASSE, ADRIENNE (RN CNM)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:PLASSE
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 KERNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4861
Mailing Address - Country:US
Mailing Address - Phone:415-507-4030
Mailing Address - Fax:415-507-2634
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-507-4030
Practice Address - Fax:415-507-2634
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355376163WW0101X
CA376367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q07546Medicare UPIN
ZZZ8291ZMedicare ID - Type Unspecified