Provider Demographics
NPI:1073139135
Name:NAKAMURA, ALYSSA LEINANI
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEINANI
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1059 ULAHEA ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5531
Mailing Address - Country:US
Mailing Address - Phone:808-227-6368
Mailing Address - Fax:
Practice Address - Street 1:95-1059 ULAHEA ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-5531
Practice Address - Country:US
Practice Address - Phone:808-227-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician