MEDICARE: JOANNE PROBERT NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95022783	CA

General Provider Information

NPI Number	:	1821713975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE PROBERT NP

Provider Business Mailing Address
First Line	:	2542 S BASCOM AVE STE 110
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-5541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 OLD BAYSHORE HWY STE 201
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1616
Country	:	US
Telephone Number	:	800-913-2615
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/11/2022

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