Healthcare Provider Details

I. General information

NPI: 1295422004
Provider Name (Legal Business Name): NICOLETTE SWEENEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLETTE ROMAN RN

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE STE 350
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

3100 TELEGRAPH AVE STE 350
OAKLAND CA
94609-3239
US

V. Phone/Fax

Practice location:
  • Phone: 949-637-2662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number777198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number89824
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: