Provider Demographics
NPI:1154501617
Name:NAKANISHI, GAY JEANNE (NP RN)
Entity Type:Individual
Prefix:MRS
First Name:GAY
Middle Name:JEANNE
Last Name:NAKANISHI
Suffix:
Gender:F
Credentials:NP RN
Other - Prefix:MS
Other - First Name:GAY
Other - Middle Name:JEANNE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:2100 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-6255
Mailing Address - Country:US
Mailing Address - Phone:949-824-8770
Mailing Address - Fax:949-824-2698
Practice Address - Street 1:2100 MEDICAL PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-6255
Practice Address - Country:US
Practice Address - Phone:949-824-8770
Practice Address - Fax:949-824-2698
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P58469Medicare UPIN
WNP8954AMedicare Oscar/Certification