Healthcare Provider Details

I. General information

NPI: 1265568778
Provider Name (Legal Business Name): SHIRLEY ENDERLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 300
OAKLAND CA
94605-2409
US

IV. Provider business mailing address

64 MUTH DR
ORINDA CA
94563-2819
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5731
  • Fax:
Mailing address:
  • Phone: 925-253-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number217485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: