Provider Demographics
NPI:1255586293
Name:PETRIE, JANE IVORY (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:IVORY
Last Name:PETRIE
Suffix:
Gender:
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:IVORY
Other - Last Name:ERNSTTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 FRIDA KAHLO WAY
Mailing Address - Street 2:HC-100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-239-3110
Mailing Address - Fax:
Practice Address - Street 1:50 FRIDA KAHLO WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1821
Practice Address - Country:US
Practice Address - Phone:415-239-3110
Practice Address - Fax:415-239-3193
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651984163WG0000X
CA18361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice