Provider Demographics
NPI:1568764553
Name:HERMOSO, MARGARET ELAINE (RN, NP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELAINE
Last Name:HERMOSO
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELAINE
Other - Last Name:JEDLICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 ARGUELLO STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-851-4900
Mailing Address - Fax:650-995-1202
Practice Address - Street 1:500 ARGUELLO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1566
Practice Address - Country:US
Practice Address - Phone:650-851-4900
Practice Address - Fax:650-995-1202
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344442163W00000X
CA19242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse