Healthcare Provider Details

I. General information

NPI: 1366226524
Provider Name (Legal Business Name): CARRIE J WHITAKER RN, PHN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE J. WHITAKER RN, PHN, MPH

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2000
  • Fax: 510-643-2997
Mailing address:
  • Phone: 510-642-2000
  • Fax: 510-643-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: