Provider Demographics
NPI:1235165762
Name:CHRISTOFOROU, MARYANNE E (RN MS)
Entity Type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:E
Last Name:CHRISTOFOROU
Suffix:
Gender:F
Credentials:RN MS
Other - Prefix:MS
Other - First Name:MARYANNE
Other - Middle Name:
Other - Last Name:HALL-PURGAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MS
Mailing Address - Street 1:1635 DIVISADERO STREET
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3010
Practice Address - Country:US
Practice Address - Phone:415-353-7128
Practice Address - Fax:415-353-7093
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA005693660Medicaid
CA005693660Medicare PIN
CA005693660Medicaid