Provider Demographics
NPI:1902014483
Name:MIHATA, EVELYN MICHIKO (RNMS)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MICHIKO
Last Name:MIHATA
Suffix:
Gender:F
Credentials:RNMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GLEN CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2318
Mailing Address - Country:US
Mailing Address - Phone:925-937-1949
Mailing Address - Fax:
Practice Address - Street 1:568 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1618
Practice Address - Country:US
Practice Address - Phone:510-268-7469
Practice Address - Fax:510-451-4307
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224239163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult