Provider Demographics
NPI:1235538570
Name:VON SYDOW, NORA (FNP)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:VON SYDOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:707-541-7900
Mailing Address - Fax:707-573-5412
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-541-7900
Practice Address - Fax:707-573-5412
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2014008837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP95001184OtherSTATE MEDICAL LICENSE
CARN788678OtherSTATE MEDICAL LICENSE
CANP95001184OtherSTATE MEDICAL LICENSE