Healthcare Provider Details

I. General information

NPI: 1841614427
Provider Name (Legal Business Name): AMY LOUISE ENCALADA DIBBLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

IV. Provider business mailing address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-4566
  • Fax: 415-291-0489
Mailing address:
  • Phone: 415-529-4566
  • Fax: 415-291-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: