Healthcare Provider Details

I. General information

NPI: 1265524755
Provider Name (Legal Business Name): GWENDOLYN ELIZABETH HAYNES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 30TH STREET ,SUITE 2
OAKLAND CA
94609
US

IV. Provider business mailing address

419 30TH STREET ,SUITE 2
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-775-2229
  • Fax: 510-590-9938
Mailing address:
  • Phone: 510-775-2229
  • Fax: 510-590-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: