Healthcare Provider Details

I. General information

NPI: 1306635024
Provider Name (Legal Business Name): JENNIFER OKONSKY RN, NP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 8TH ST
PETALUMA CA
94952-4153
US

IV. Provider business mailing address

414 8TH ST
PETALUMA CA
94952-4153
US

V. Phone/Fax

Practice location:
  • Phone: 415-722-8663
  • Fax:
Mailing address:
  • Phone: 415-722-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: