Healthcare Provider Details

I. General information

NPI: 1104692656
Provider Name (Legal Business Name): BRIANA WILBORN CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

530 41ST ST APT 2
OAKLAND CA
94609-2441
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4800
  • Fax:
Mailing address:
  • Phone: 916-548-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95027673
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: