Provider Demographics
NPI:1861213282
Name:LI, CHRISTY J (NP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:J
Last Name:LI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 SAN LEANDRO ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3443
Mailing Address - Country:US
Mailing Address - Phone:510-432-5084
Mailing Address - Fax:
Practice Address - Street 1:3503 SAN LEANDRO ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3443
Practice Address - Country:US
Practice Address - Phone:510-432-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95032464363LF0000X
CARN95242065163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily