Provider Demographics
NPI:1548851546
Name:ROSSITER, PHOEBE (RN, PHN)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:ROSSITER
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1227
Mailing Address - Country:US
Mailing Address - Phone:510-910-1121
Mailing Address - Fax:
Practice Address - Street 1:384 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3211
Practice Address - Country:US
Practice Address - Phone:510-504-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745411261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care