Provider Demographics
NPI:1477628881
Name:BAKER, JILL GISVOLD (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:GISVOLD
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1654
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-1654
Mailing Address - Country:US
Mailing Address - Phone:415-455-8535
Mailing Address - Fax:
Practice Address - Street 1:2238 GEARY BLVD
Practice Address - Street 2:FOUR SOUTHWEST
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-833-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP26061Medicare UPIN