Provider Demographics
NPI:1881958049
Name:JACKSON-VOGLER, ELISIA (NURSE)
Entity type:Individual
Prefix:
First Name:ELISIA
Middle Name:
Last Name:JACKSON-VOGLER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 GEARY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3416
Mailing Address - Country:US
Mailing Address - Phone:415-833-2177
Mailing Address - Fax:415-833-3235
Practice Address - Street 1:2238 GEARY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-833-2177
Practice Address - Fax:415-833-3235
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546844163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care