Healthcare Provider Details

I. General information

NPI: 1073888509
Provider Name (Legal Business Name): JEAN FAYE HAREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE SUITE 125A
OAKLAND CA
94605-2403
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125A
OAKLAND CA
94605-2403
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-3859
  • Fax: 510-777-3806
Mailing address:
  • Phone: 510-777-3859
  • Fax: 510-777-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number611118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: