=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073883013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA KAY BIERUT MSN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2012
-----------------------------------------------------
Last Update Date | 09/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1985 FIRST ST STE 205
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-484-5483
-----------------------------------------------------
Fax | 925-484-5427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1985 FIRST ST STE 205
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-484-5483
-----------------------------------------------------
Fax | 925-484-5427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | NP 21432
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------