Provider Demographics
NPI:1508082645
Name:OKAMOTO, NANCY ITSUYO (NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ITSUYO
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ITSUYO
Other - Middle Name:NANCY
Other - Last Name:OKAMOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1432 HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1316
Mailing Address - Country:US
Mailing Address - Phone:510-352-6586
Mailing Address - Fax:
Practice Address - Street 1:50 PHELAN AVE
Practice Address - Street 2:HEALTH CENTER 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1821
Practice Address - Country:US
Practice Address - Phone:415-239-3192
Practice Address - Fax:415-239-3193
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner