Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | PENDING | CA |
NPI | 1598372690 |
---|---|
Provider Name | Mr. Heshimu Jamal Mccrainey |
First Address | Oakland, CA 94610-3536 |
Second Address | San Francisco, CA 94110-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |