MEDICARE: MRS. MARYA W OAKES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	NP15701	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ06588Z	OTHER	CA	INDIVIDUAL MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ25352Z	OTHER	CA	GROUP PTAN

General Provider Information

NPI Number	:	1912978263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYA W OAKES FNP

Provider Business Mailing Address
First Line	:	420 W ACACIA ST
Second Line	:	STE 1
City	:	STOCKTON
State	:	CA
Zip	:	95203-2441
Country	:	US
Telephone Number	:	209-948-1583
Fax Number	:	209-948-3564

Provider Business Practice Location Address
First Line	:	1508 WEST LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-3340
Country	:	US
Telephone Number	:	209-948-2886
Fax Number	:	209-948-2831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/16/2016

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