MEDICARE: DEBORAH ANN JERNBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	444213	CA
2	363LF0000X	Family Nurse Practitioner	NPF 8192	CA

General Provider Information

NPI Number	:	1780751032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN JERNBERG

Provider Business Mailing Address
First Line	:	655 REDWOOD HWY
Second Line	:	SUITE 200
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 REDWOOD BLVD
Second Line	:	SUITE 200, CONTINUITY OF CARE
City	:	NOVATO
State	:	CA
Zip	:	94945-3250
Country	:	US
Telephone Number	:	415-893-4050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/11/2007

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Directions to “ DEBORAH ANN JERNBERG ” Practice Location

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