Provider Demographics
NPI:1255221982
Name:TANABE, KATHRYN SANAE (FNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SANAE
Last Name:TANABE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 FRIARS RD APT 1313
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-6005
Mailing Address - Country:US
Mailing Address - Phone:808-222-5025
Mailing Address - Fax:
Practice Address - Street 1:5845 FRIARS RD APT 1313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-6005
Practice Address - Country:US
Practice Address - Phone:808-222-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily