Provider Demographics
NPI:1619365384
Name:LOUIE, SHIRLEY ITING (FNP)
Entity Type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:ITING
Last Name:LOUIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:I-TING
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:750 REDWOOD HWY FRONTAGE RD STE 1204
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2483
Practice Address - Country:US
Practice Address - Phone:415-384-4778
Practice Address - Fax:415-384-4779
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA810087163W00000X
CANP95001877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse