Healthcare Provider Details

I. General information

NPI: 1467813683
Provider Name (Legal Business Name): ELISABETH ANNE SHERRATT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SUMMIT ST 2ND FLOOR, SUITE 2549
OAKLAND CA
94609-3412
US

IV. Provider business mailing address

1152 BISMARCK LN
ALAMEDA CA
94502-6962
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8865
  • Fax:
Mailing address:
  • Phone: 155-928-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003800
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95029500
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-302627
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: