Healthcare Provider Details

I. General information

NPI: 1285790816
Provider Name (Legal Business Name): DENA LEE PROCTOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

4801 WALNUT ST
OAKLAND CA
94619-2558
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8650
  • Fax:
Mailing address:
  • Phone: 510-434-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number657596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: