Healthcare Provider Details

I. General information

NPI: 1558544858
Provider Name (Legal Business Name): ADRIENNE KERNAN RN PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24085 AMADOR ST #110
HAYWARD CA
94544
US

IV. Provider business mailing address

24085 AMADOR ST #110
HAYWARD CA
94544
US

V. Phone/Fax

Practice location:
  • Phone: 510-589-0801
  • Fax: 510-670-8466
Mailing address:
  • Phone: 510-589-0801
  • Fax: 510-670-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: