Provider Demographics
NPI:1144413923
Name:STACY R. BISCHOFF, RN, NP, PC
Entity Type:Organization
Organization Name:STACY R. BISCHOFF, RN, NP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NP
Authorized Official - Phone:415-456-7906
Mailing Address - Street 1:1 BRACKEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1587
Mailing Address - Country:US
Mailing Address - Phone:415-456-7906
Mailing Address - Fax:415-456-7991
Practice Address - Street 1:1368 LINCOLN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2147
Practice Address - Country:US
Practice Address - Phone:415-454-4325
Practice Address - Fax:415-454-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2129357314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS83038Medicare UPIN
CAZZZ16535ZMedicare PIN