Healthcare Provider Details

I. General information

NPI: 1194123653
Provider Name (Legal Business Name): JESSICA V SEWARD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 PACHECO ST
CONCORD CA
94520-2019
US

IV. Provider business mailing address

1510 4TH ST 1
BERKELEY CA
94710-1717
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-8978
  • Fax:
Mailing address:
  • Phone: 510-525-8980
  • Fax: 510-525-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: