Canavan, Mary Beth

Canavan, Mary Beth is an individual health care provider with primary practice located at 1030 International Blvd , Oakland CA 94606-3730. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Canavan, Mary Beth can be contacted via phone (510) 238-5400.

Contact Information

Primary practice address
1030 International Blvd Oakland CA 94606-3730
Phone: (510) 238-5400
Fax: (510) 238-5437
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X NMW1440 California

Profile Details

NPI number 1326148677
LBN Legal business name Canavan, Mary Beth
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2006
Last updated Aug 3rd, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326148677 NPPES
California Other ZZZ79046Z FQHC MEDICARE PART B
California Other 05-1822 FQHC MEDICARE PART B
California Other HAP11991F FQHC MEDICARE PART B
California MEDICAID FHC11991F FQHC MEDICARE PART B

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