Provider Demographics
NPI:1942380738
Name:AXELROD, JESSICA PURDY (PNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PURDY
Last Name:AXELROD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:FRANKLIN
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:259 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1236
Mailing Address - Country:US
Mailing Address - Phone:650-384-0568
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16715363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics