Basic Information
| Provider Information | |||||||||
| NPI: | 1275665200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WISH | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2950 INTERNATIONAL BLVD | ||||||||
| Address2: | NATIVE AMERICAN HEALTH CENTER | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2950 INTERNATIONAL BLVD | ||||||||
| Address2: | NATIVE AMERICAN HEALTH CENTER | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN272107 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health | 363LP2300X | NPF4281 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.