Provider Demographics
NPI:1689649295
Name:BERRIATUA, KATHLEEN ANN (FNP, CNS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:BERRIATUA
Suffix:
Gender:F
Credentials:FNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 BACON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2045
Mailing Address - Country:US
Mailing Address - Phone:925-676-3450
Mailing Address - Fax:
Practice Address - Street 1:2299 BACON ST STE 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2045
Practice Address - Country:US
Practice Address - Phone:925-676-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily