Provider Demographics
NPI:1053648402
Name:TRUSKIER, MARY WILLIAMS (RN, MS, PNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:WILLIAMS
Last Name:TRUSKIER
Suffix:
Gender:F
Credentials:RN, MS, PNP
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Mailing Address - Street 1:3138 LEWISTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2717
Mailing Address - Country:US
Mailing Address - Phone:510-428-3690
Mailing Address - Fax:510-235-2173
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:CHILDREN'S HOSPITAL SURGICAL SERVICES
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3690
Practice Address - Fax:510-235-2173
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2101363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-30382330Medicaid