Healthcare Provider Details

I. General information

NPI: 1922240183
Provider Name (Legal Business Name): FERN CUDLIP FNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20103 LAKE CHABOT RD NEUROSCIENCE DEPARTMENT
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

20103 LAKE CHABOT RD NEUROSCIENCE DEPARTMENT
CASTRO VALLEY CA
94546-5305
US

V. Phone/Fax

Practice location:
  • Phone: 510-728-1634
  • Fax: 510-727-1484
Mailing address:
  • Phone: 510-728-1634
  • Fax: 510-727-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP7711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: