Healthcare Provider Details

I. General information

NPI: 1457780520
Provider Name (Legal Business Name): ANGELA HIEBERT RN, MN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LOEWEN

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST BMT OFFICE 2ND FLOOR MAIN HOSPITAL
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST BMT OFFICE 2ND FLOOR MAIN HOSPITAL
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-597-7169
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-597-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: