Provider Demographics
NPI:1386232395
Name:IWAMOTO, ALLISON EMIKO (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:EMIKO
Last Name:IWAMOTO
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 FREEPORT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2015
Mailing Address - Country:US
Mailing Address - Phone:916-422-7273
Mailing Address - Fax:
Practice Address - Street 1:4617 FREEPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-2015
Practice Address - Country:US
Practice Address - Phone:916-422-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95077357163W00000X
CA95010444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse