Provider Demographics
NPI:1962828244
Name:DERMAN, MICHELLE (WHNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DERMAN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DERMAN-BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7526
Mailing Address - Fax:
Practice Address - Street 1:8480 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1318
Practice Address - Country:US
Practice Address - Phone:510-746-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001666363LW0102X, 363LW0102X
CA95045426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse