Basic Information
| Provider Information | |||||||||
| NPI: | 1801224217 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ENTEEN | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 MACARTHUR BLVD | ||||||||
| Address2: | SUITE 14B | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946055298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105634300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10700 MACARTHUR BLVD | ||||||||
| Address2: | SUITE 14B | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946055298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105634300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2013 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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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 | 364SP0808X | 23752 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 363LP2300X | 783617 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.