Healthcare Provider Details

I. General information

NPI: 1922638493
Provider Name (Legal Business Name): DANA JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 OAKLAND AVE
OAKLAND CA
94611-4567
US

IV. Provider business mailing address

10816 JULIUS ST
OAKLAND CA
94605-5234
US

V. Phone/Fax

Practice location:
  • Phone: 707-205-6658
  • Fax:
Mailing address:
  • Phone: 707-205-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number643075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: