Provider Demographics
NPI:1083621254
Name:NAKAO, LARA JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:JOY
Last Name:NAKAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3404
Mailing Address - Country:US
Mailing Address - Phone:610-279-8686
Mailing Address - Fax:610-279-1588
Practice Address - Street 1:1308 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3404
Practice Address - Country:US
Practice Address - Phone:610-279-8686
Practice Address - Fax:610-279-1588
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004556363A00000X
PAMA051881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50051163OtherBLUE CROSS
PA50051163OtherBLUE CROSS
PA085464Medicare ID - Type Unspecified