Provider Demographics
NPI:1447266747
Name:REDFERN, MARY A (APRN,BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:REDFERN
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DRAKES LANDING RD # A
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2404
Mailing Address - Country:US
Mailing Address - Phone:415-924-1214
Mailing Address - Fax:
Practice Address - Street 1:100 DRAKES LANDING RD # A
Practice Address - Street 2:SUITE 225
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2404
Practice Address - Country:US
Practice Address - Phone:415-924-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily