Healthcare Provider Details

I. General information

NPI: 1245779669
Provider Name (Legal Business Name): LOUISE TSUKAHARA RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD NEONATAL ICU
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2560 S CENTINELA AVE #14
LOS ANGELES CA
90064-2775
US

V. Phone/Fax

Practice location:
  • Phone: 310-996-1977
  • Fax:
Mailing address:
  • Phone: 310-996-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number21365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number390463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: