Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NP7287 | CA |
NPI | 1497963300 |
---|---|
Provider Name | Harriet Ichiyama |
First Address | Fresno, CA 93728-3419 |
Second Address | Fresno, CA 93728-3419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |