Healthcare Provider Details

I. General information

NPI: 1801264874
Provider Name (Legal Business Name): LILLIAN MARGARET NELSON DUBRALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD # 350
OAKLAND CA
94605-2455
US

IV. Provider business mailing address

1125 WARFIELD AVE
PIEDMONT CA
94610-1613
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: