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NPI Code Detail

MEDICARE: VANESSA MARIE MAYEN R.N., N.P.

MEDICARE: VANESSA MARIE MAYEN R.N., N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse95038673CA
2363LF0000XFamily Nurse Practitioner95004864CA

General Provider Information

NPI Number : 1023462694
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA MARIE MAYEN R.N., N.P.
Provider Business Mailing Address
First Line : PO BOX 11247
Second Line :
City : BERKELEY
State : CA
Zip : 94712-2247
Country : US
Telephone Number : 510-981-4100
Fax Number :
Provider Business Practice Location Address
First Line : 837 ADDISON ST
Second Line :
City : BERKELEY
State : CA
Zip : 94710-2047
Country : US
Telephone Number : 510-981-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2016
Last Update Date : 09/14/2022

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