Provider Demographics
NPI:1033921200
Name:MACKERROW, KATHLEEN VIRGINIA (MS, RN, CNS, GCNS-BC)
Entity type:Individual
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First Name:KATHLEEN
Middle Name:VIRGINIA
Last Name:MACKERROW
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Gender:F
Credentials:MS, RN, CNS, GCNS-BC
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Mailing Address - Street 1:139 HUGO ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2761
Mailing Address - Country:US
Mailing Address - Phone:415-215-5259
Mailing Address - Fax:
Practice Address - Street 1:375 LAGUNA HONDA BLVD OFC A412
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-759-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA457518163WN0800X
CA1253364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience