Provider Demographics
NPI:1770504300
Name:CADEMARTORI, JENNIFER LYNN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:CADEMARTORI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:SUITE 607, BOX 0116
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-1013
Mailing Address - Fax:415-353-8917
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:SUITE 607, BOX 0116
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-1013
Practice Address - Fax:415-353-8917
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN652742OtherMEDI-CAL PIN#
CAZZZ02495ZMedicare PIN
CARN652742OtherMEDI-CAL PIN#