Provider Demographics
NPI:1538248927
Name:DELISSER, ROSALIND MC NIESH (APRN, PMHNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:MC NIESH
Last Name:DELISSER
Suffix:
Gender:F
Credentials:APRN, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1205
Mailing Address - Country:US
Mailing Address - Phone:415-741-4144
Mailing Address - Fax:
Practice Address - Street 1:2 KORET WAY RM N505G
Practice Address - Street 2:BOX 0608
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0608
Practice Address - Country:US
Practice Address - Phone:415-476-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13984363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ21272Medicare UPIN