Healthcare Provider Details

I. General information

NPI: 1386977700
Provider Name (Legal Business Name): STEPHEN DANIEL INGERSON RN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

V. Phone/Fax

Practice location:
  • Phone: 707-365-6304
  • Fax:
Mailing address:
  • Phone: 707-365-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number584959
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number3210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: