Healthcare Provider Details

I. General information

NPI: 1891195806
Provider Name (Legal Business Name): JOURNEY MEADOWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

IV. Provider business mailing address

505 PARNASSUS AVE 15 LONG
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-6060
  • Fax: 510-425-4595
Mailing address:
  • Phone: 415-502-4906
  • Fax: 415-514-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: