Provider Demographics
NPI:1548399363
Name:NAKAISHI, MICHELLE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:NAKAISHI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:NAKAISHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:OFFICES 770 53RD ST
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-601-3973
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:OFFICES 770 - 53RD ST.
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-601-3973
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16716363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics