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General NPI Number Information
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NPI Number | 1861748832
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Entity Type | Individual
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Provider Name | ELIZABETH WYTYCHAK DODS NP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6121 HOLLIS ST STE 400
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City | EMERYVILLE
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State | CA
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Zip | 94608-2077
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Country | US
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Telephone | 510-266-5401
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Fax |
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Provider Business Mailing Address
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Address Line | 6121 HOLLIS ST STE 400
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City | EMERYVILLE
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State | CA
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Zip | 94608-2077
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Country | US
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Telephone | 510-266-5401
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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 | AP60411118
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 98811
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 005605
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95031987
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License Number State | CA
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