Healthcare Provider Details

I. General information

NPI: 1083081608
Provider Name (Legal Business Name): OLIVIA DEBREE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA DE BREE NP

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE STREET, SUITE 280 LIFELONG MEDICAL CARE, ASHBY HEALTH CENTER
BERKELEY CA
94703
US

IV. Provider business mailing address

3075 ADELINE STREET, SUITE 280 LIFELONG MEDICAL CARE, ASHBY HEALTH CENTER
BERKELEY CA
94703
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-4100
  • Fax:
Mailing address:
  • Phone: 510-981-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95002949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: