Healthcare Provider Details

I. General information

NPI: 1851678510
Provider Name (Legal Business Name): ELISSA MARIE DEWOLFE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BROADWAY SUITE 300
OAKLAND CA
94611-5613
US

IV. Provider business mailing address

3701 BROADWAY SUITE 300
OAKLAND CA
94611-5613
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-4089
  • Fax: 510-752-1835
Mailing address:
  • Phone: 510-752-4089
  • Fax: 510-752-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: