Healthcare Provider Details

I. General information

NPI: 1861305708
Provider Name (Legal Business Name): CHRISTINE ANN MIASKOWSKI RN, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DOROTHY WAY
NOVATO CA
94945-1632
US

IV. Provider business mailing address

44 DOROTHY WAY
NOVATO CA
94945-1632
US

V. Phone/Fax

Practice location:
  • Phone: 415-713-7657
  • Fax: 415-476-8899
Mailing address:
  • Phone: 415-713-7657
  • Fax: 415-476-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number490597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: