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General NPI Number Information
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NPI Number | 1447765698
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Entity Type | Individual
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Provider Name | MAE JENNIFER LE
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 2344 6TH ST
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City | BERKELEY
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State | CA
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Zip | 94710-2412
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Country | US
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Telephone | 510-981-4100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11247
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City | BERKELEY
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State | CA
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Zip | 94712-2247
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Country | US
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Telephone | 510-981-4100
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95008071
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95008071
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License Number State | CA
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