Basic Information
Provider Information | |||||||||
NPI: | 1477848604 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHERN | ||||||||
FirstName: | DEVYN | ||||||||
MiddleName: | MICHELLE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NISHIKAWA | ||||||||
OtherFirstName: | DEVYN | ||||||||
OtherMiddleName: | MICHELLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1800 HARRISON ST | ||||||||
Address2: | 7TH FLOOR | ||||||||
City: | OAKLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 946123466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5106256262 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1800 HARRISON ST | ||||||||
Address2: | 7TH FLOOR | ||||||||
City: | OAKLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 946123466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5106256262 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2011 | ||||||||
LastUpdateDate: | 06/20/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/20/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3999 | CA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.