Provider Demographics
NPI:1700416138
Name:JESSUP, CATHERINE MOLLY (NP-C)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MOLLY
Last Name:JESSUP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 1708
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4101
Mailing Address - Country:US
Mailing Address - Phone:415-392-3200
Mailing Address - Fax:415-392-3201
Practice Address - Street 1:450 SUTTER ST RM 1708
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4101
Practice Address - Country:US
Practice Address - Phone:415-392-3200
Practice Address - Fax:415-392-3201
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95159695163W00000X
CA95013745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770519233OtherNPI