Healthcare Provider Details

I. General information

NPI: 1912180092
Provider Name (Legal Business Name): ELIZABETH ROWAN RN, MSN, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROADWAY SUITE 500
OAKLAND CA
94607-4099
US

IV. Provider business mailing address

1000 BROADWAY SUITE 500
OAKLAND CA
94607-4099
US

V. Phone/Fax

Practice location:
  • Phone: 510-267-3250
  • Fax: 510-268-2111
Mailing address:
  • Phone: 510-267-3250
  • Fax: 510-268-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number569189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: