Healthcare Provider Details

I. General information

NPI: 1770509010
Provider Name (Legal Business Name): KRISTI HANEY CHAMBERS CLINICAL NURSE SPEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST 116-C
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

880 LAS OVEJAS AVE
SAN RAFAEL CA
94903-3110
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-479-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number306159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: