Provider Demographics
NPI:1255783080
Name:KOPP-YATES, HANNAH ROWENA (RN, CNM)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROWENA
Last Name:KOPP-YATES
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2141
Mailing Address - Country:US
Mailing Address - Phone:510-289-6169
Mailing Address - Fax:
Practice Address - Street 1:583 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5239
Practice Address - Country:US
Practice Address - Phone:510-289-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95091541163W00000X
CA235831367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse