Healthcare Provider Details

I. General information

NPI: 1518827070
Provider Name (Legal Business Name): LAKENDRA CORNELIUS MSN, MPH, APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 270
BERKELEY CA
94703-2580
US

IV. Provider business mailing address

3075 ADELINE ST STE 270-280
BERKELEY CA
94703-2576
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-5600
  • Fax: 510-506-7722
Mailing address:
  • Phone: 510-204-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: