Provider Demographics
NPI:1598882961
Name:ERNSTROM, NATALEE (NP, MSN)
Entity Type:Individual
Prefix:MS
First Name:NATALEE
Middle Name:
Last Name:ERNSTROM
Suffix:
Gender:F
Credentials:NP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CAYUGA AVE
Mailing Address - Street 2:BALBOA TEEN HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3236
Mailing Address - Country:US
Mailing Address - Phone:415-469-4512
Mailing Address - Fax:415-469-4096
Practice Address - Street 1:1000 CAYUGA AVE
Practice Address - Street 2:BALBOA TEEN HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3236
Practice Address - Country:US
Practice Address - Phone:415-469-4512
Practice Address - Fax:415-469-4096
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 546703163WC1500X
CANPF11774363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
068122OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
P21890Medicare UPIN