Provider Demographics
NPI:1790829844
Name:WHITTENVILE, CAROL DIANE (RN, CNS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DIANE
Last Name:WHITTENVILE
Suffix:
Gender:F
Credentials:RN, CNS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:801 ROSEMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2408
Mailing Address - Country:US
Mailing Address - Phone:510-835-0559
Mailing Address - Fax:510-835-0559
Practice Address - Street 1:3900 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5616
Practice Address - Country:US
Practice Address - Phone:415-570-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373310163WP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult