MEDICARE: AMY MARGRETHE WILLATS RN, CNM, NP

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
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	569208	CA
2	363LW0102X	Women's Health Nurse Practitioner	13379	CA
3	367A00000X	Advanced Practice Midwife	1559	CA

General Provider Information

NPI Number	:	1346309697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARGRETHE WILLATS RN, CNM, NP

Provider Business Mailing Address
First Line	:	PO BOX 22210
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94623-2210
Country	:	US
Telephone Number	:	510-535-3655
Fax Number	:	510-535-4189

Provider Business Practice Location Address
First Line	:	3451 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3463
Country	:	US
Telephone Number	:	510-535-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/30/2021

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