Basic Information
| Provider Information | |||||||||
| NPI: | 1093867715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNIS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | KAISER PERMANENTE GENETICS DEPARTMENT | ||||||||
| Address2: | 280 W. MACARTHUR BLVD | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107526298 | ||||||||
| FaxNumber: | 5107526754 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 W MACARTHUR BLVD | ||||||||
| Address2: | GENETICS DEPARTMENT | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107526298 | ||||||||
| FaxNumber: | 5107526754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.