Healthcare Provider Details

I. General information

NPI: 1629273180
Provider Name (Legal Business Name): ABIGAIL WOLF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 16TH ST
OAKLAND CA
94612
US

IV. Provider business mailing address

559 16TH ST
OAKLAND CA
94612-1515
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-5091
  • Fax:
Mailing address:
  • Phone: 510-238-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number673640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number673640
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number673640
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95009947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: