Healthcare Provider Details

I. General information

NPI: 1801971783
Provider Name (Legal Business Name): SUSAN JEANNE OASE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

7373 WEST LN
STOCKTON CA
95210-3377
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-2080
  • Fax:
Mailing address:
  • Phone: 209-476-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: