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General NPI Number Information
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NPI Number | 1073651154
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Entity Type | Individual
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Provider Name | JESSE WOISARD WENNIK NP, CNS
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 250 BON AIR RD
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-499-6835
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Fax | 415-507-4113
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Provider Business Mailing Address
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Address Line | 250 BON AIR RD SUITE B
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-473-2964
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Fax | 415-473-4113
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 16967
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 16967
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License Number State | CA
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