Healthcare Provider Details

I. General information

NPI: 1669206736
Provider Name (Legal Business Name): INDIGO JOANNA WEBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 5
SAN FRANCISCO CA
94158-2604
US

IV. Provider business mailing address

415 BELLEVUE AVE APT 31
OAKLAND CA
94610-4916
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-9721
  • Fax:
Mailing address:
  • Phone: 603-289-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number95181536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95181536
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberNP95035793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: