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General NPI Number Information
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NPI Number | 1396266987
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Entity Type | Individual
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Provider Name | AMSALE GUGESSA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 9925 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94603-2558
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Country | US
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Telephone | 510-777-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 PARKSIDE DR
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City | WALNUT CREEK
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State | CA
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Zip | 94597-3561
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Country | US
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Telephone | 925-278-3269
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006485
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License Number State | CA
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