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General NPI Number Information
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NPI Number | 1043873557
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Entity Type | Individual
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Provider Name | LEA SHANGRAW FOX FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 747 52ND ST
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City | OAKLAND
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State | CA
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Zip | 94609-1809
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Country | US
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Telephone | 510-428-3885
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Fax | 510-597-7148
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Provider Business Mailing Address
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Address Line | 3254 FAIRVIEW AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-1704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 95011513
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95011513
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License Number State | CA
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