Provider Demographics
NPI:1043666894
Name:OLMEDA, NINA (KRM)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:OLMEDA
Suffix:
Gender:F
Credentials:KRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRAYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1036
Mailing Address - Country:US
Mailing Address - Phone:413-297-1596
Mailing Address - Fax:
Practice Address - Street 1:35 BRAYWOOD CIR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1036
Practice Address - Country:US
Practice Address - Phone:413-297-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAKM84310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKM84310OtherKARUNA REIKI MASTER