Provider Demographics
NPI:1184074072
Name:WESLEY, JERICA (RN)
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4853
Mailing Address - Country:US
Mailing Address - Phone:925-864-4200
Mailing Address - Fax:510-568-0685
Practice Address - Street 1:9933 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4853
Practice Address - Country:US
Practice Address - Phone:925-864-4200
Practice Address - Fax:510-568-0685
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818371163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health