Healthcare Provider Details

I. General information

NPI: 1831374834
Provider Name (Legal Business Name): ROWENA A FANER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

607 WINDSOR
HERCULES CA
94547-3831
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4444
  • Fax:
Mailing address:
  • Phone: 707-423-4066
  • Fax: 707-423-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number526981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: