Provider Demographics
NPI:1669813382
Name:RASKOFF, KELLY MCMILLAN (MSN, RN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCMILLAN
Last Name:RASKOFF
Suffix:
Gender:F
Credentials:MSN, RN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2407
Mailing Address - Country:US
Mailing Address - Phone:925-330-1640
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:INTENSIVE CARE NURSERY- 3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:415-353-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23090363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal