Provider Demographics
NPI:1942342084
Name:LUCILLE PACKARD CHILDREN'S HOSPITAL 030962
Entity Type:Organization
Organization Name:LUCILLE PACKARD CHILDREN'S HOSPITAL 030962
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, PNP
Authorized Official - Phone:650-804-0749
Mailing Address - Street 1:999 EVELYN TER W
Mailing Address - Street 2:#69
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6777
Mailing Address - Country:US
Mailing Address - Phone:650-804-0749
Mailing Address - Fax:
Practice Address - Street 1:780 WELCH RD
Practice Address - Street 2:206
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1516
Practice Address - Country:US
Practice Address - Phone:650-723-6439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531033282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren