Basic Information
| Provider Information | |||||||||
| NPI: | 1508368341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE NOCKER | ||||||||
| FirstName: | YANICKA | ||||||||
| MiddleName: | LEYLAH DOREEN | ||||||||
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| OtherLastName: | DE NOCKER | ||||||||
| OtherFirstName: | NICKY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | WRIGHT INSTITUTE CLINICAL SERVICES | ||||||||
| Address2: | 1918 UNIVERSITY AVENUE, SUITE 2B | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108411262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1918 UNIVERSITY AVE STE 2B | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947043264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108411262 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2018 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.