Provider Demographics
NPI:1447463229
Name:JAMES, ELLEN BUTENSKY (PHD, PNP)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BUTENSKY
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHD, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-450-5813
Practice Address - Street 1:747 52ND STREET
Practice Address - Street 2:OPC 1ST FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-450-5877
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10228363LP0200X
CA547786163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics