Provider Demographics
NPI:1154034122
Name:BURRELL, ETECIA ELAINA MARIE (CD, CLC RH)
Entity type:Individual
Prefix:MRS
First Name:ETECIA
Middle Name:ELAINA MARIE
Last Name:BURRELL
Suffix:
Gender:F
Credentials:CD, CLC RH
Other - Prefix:MS
Other - First Name:ETECIA
Other - Middle Name:ELAINA MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2904 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3411
Mailing Address - Country:US
Mailing Address - Phone:415-841-3915
Mailing Address - Fax:
Practice Address - Street 1:2904 CARMEL ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3411
Practice Address - Country:US
Practice Address - Phone:415-841-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula