Provider Demographics
NPI:1477975860
Name:KOLODRUBETZ, HIVA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HIVA
Middle Name:
Last Name:KOLODRUBETZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:HIVA
Other - Middle Name:
Other - Last Name:SHAFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:#320
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-465-6700
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:#320
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-465-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289237163WP2201X
CA95002980363LF0000X
CA95070213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163W00000XNursing Service ProvidersRegistered Nurse