Provider Demographics
NPI:1912978263
Name:OAKES, MARYA W (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARYA
Middle Name:W
Last Name:OAKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W ACACIA ST
Mailing Address - Street 2:STE 1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2441
Mailing Address - Country:US
Mailing Address - Phone:209-948-1583
Mailing Address - Fax:209-948-3564
Practice Address - Street 1:1508 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3340
Practice Address - Country:US
Practice Address - Phone:209-948-2886
Practice Address - Fax:209-948-2831
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15701363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06588ZOtherINDIVIDUAL MEDICARE PTAN
CAZZZ25352ZOtherGROUP PTAN