Provider Demographics
NPI:1326104472
Name:UMEH, LAURIE (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:UMEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5642
Mailing Address - Country:US
Mailing Address - Phone:510-307-2975
Mailing Address - Fax:
Practice Address - Street 1:235 W MACARTHUR BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-675-5500
Practice Address - Fax:510-752-1604
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309538363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17576Medicare UPIN