Provider Demographics
NPI:1457860470
Name:WANJALA, BUTSINA MARTHA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BUTSINA
Middle Name:MARTHA
Last Name:WANJALA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4003
Mailing Address - Country:US
Mailing Address - Phone:415-503-6000
Mailing Address - Fax:415-503-6099
Practice Address - Street 1:229 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4003
Practice Address - Country:US
Practice Address - Phone:415-503-6000
Practice Address - Fax:415-503-6096
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA762940163W00000X
CA95006296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse