Healthcare Provider Details

I. General information

NPI: 1790313047
Provider Name (Legal Business Name): MACY SUN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 67A
OAKLAND CA
94605-2455
US

IV. Provider business mailing address

6955 FOOTHILL BLVD
OAKLAND CA
94605-2455
US

V. Phone/Fax

Practice location:
  • Phone: 510-969-5067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number95006661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: