Provider Demographics
NPI:1013331602
Name:SHE'E'LA'KE'E', OATZI'NU (IAMP- MEDICINE MAN)
Entity Type:Individual
Prefix:
First Name:OATZI'NU
Middle Name:
Last Name:SHE'E'LA'KE'E'
Suffix:
Gender:M
Credentials:IAMP- MEDICINE MAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4139
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:
Practice Address - Street 1:4441 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4139
Practice Address - Country:US
Practice Address - Phone:916-473-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1402610820101YA0400X
NM2300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174400000XOther Service ProvidersSpecialist