Provider Demographics
NPI:1760690002
Name:OMAHEN, NANCY MARIE (NP)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:MARIE
Last Name:OMAHEN
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 1:101 GROVE ST
Mailing Address - Street 2:ROOM 217
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-554-2793
Mailing Address - Fax:415-554-2562
Practice Address - Street 1:101 GROVE ST
Practice Address - Street 2:ROOM 217
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4505
Practice Address - Country:US
Practice Address - Phone:415-554-2793
Practice Address - Fax:415-554-2562
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380037363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health