Provider Demographics
NPI:1124551494
Name:WOLFE-ROUBATIS, EMILY CHANA (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHANA
Last Name:WOLFE-ROUBATIS
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 LENOX AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4675
Mailing Address - Country:US
Mailing Address - Phone:617-413-4494
Mailing Address - Fax:
Practice Address - Street 1:1450 FRUITVALE AVE FL 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2313
Practice Address - Country:US
Practice Address - Phone:510-535-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235889176B00000X
CA95014754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No176B00000XOther Service ProvidersMidwife