Healthcare Provider Details

I. General information

NPI: 1760690002
Provider Name (Legal Business Name): NANCY MARIE OMAHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GROVE ST ROOM 217
SAN FRANCISCO CA
94102-4505
US

IV. Provider business mailing address

101 GROVE ST ROOM 217
SAN FRANCISCO CA
94102-4505
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-2793
  • Fax: 415-554-2562
Mailing address:
  • Phone: 415-554-2793
  • Fax: 415-554-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number380037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: