Healthcare Provider Details

I. General information

NPI: 1053749358
Provider Name (Legal Business Name): JESSICA LINNANE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N WIGET LN
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

604 STALEY AVE
HAYWARD CA
94541-6288
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-9806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: