Provider Demographics
NPI:1346006970
Name:BLACK, JEANETTE (DNP, RN, DIPACLM)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:DNP, RN, DIPACLM
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:LANDUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,BSN,RN
Mailing Address - Street 1:9110 ALCOSTA BLVD. STE H #305
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3852
Mailing Address - Country:US
Mailing Address - Phone:925-502-5606
Mailing Address - Fax:
Practice Address - Street 1:9110 ALCOSTA BLVD. STE H #305
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3852
Practice Address - Country:US
Practice Address - Phone:925-502-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
CA408352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach