Provider Demographics
NPI:1316015381
Name:OPALKA, MOIRA (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:
Last Name:OPALKA
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-3224
Mailing Address - Fax:
Practice Address - Street 1:3 HARBOR DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1454
Practice Address - Country:US
Practice Address - Phone:415-380-0480
Practice Address - Fax:415-380-8788
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61089224363LF0000X
CA11549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP70888Medicare UPIN
CAZZZ24446ZMedicare PIN