Healthcare Provider Details

I. General information

NPI: 1447463229
Provider Name (Legal Business Name): ELLEN BUTENSKY JAMES PHD, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND STREET OPC 1ST FLOOR
OAKLAND CA
94609
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-450-5877
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-450-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP10228
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number547786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: