Active NPI
Nicky Reynicke
- Registered Nurse
- Oakland, CA
National Provider Identifier
1760121305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 95042307
- Practice address
- 1411 E 31St St
Oakland, CA 94602-1092 - Phone
- (510) 437-4881
- NPI assigned
- Jun 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 95042307 | CA | Primary |
Addresses
Primary practice location
1411 E 31St St
Oakland, CA 94602-1092
Mailing address
746 City Walk PL Apt 1
Hayward, CA 94541-6661
Phone (727) 492-4097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95042307 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654128000000",
"number": "1760121305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "746 CITY WALK PL APT 1",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945416661",
"telephone_number": "727-492-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 E 31ST ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021092",
"telephone_number": "510-437-4881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNICKE",
"first_name": "NICKY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-01",
"last_updated": "2022-06-02",
"certification_date": "2022-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "CA",
"license": "95042307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.