Provider Demographics
NPI:1114372208
Name:NAKANO, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NAKANO
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 1:17372 SW LAWTON ST
Mailing Address - Street 2:APT 206
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-7613
Mailing Address - Country:US
Mailing Address - Phone:360-710-8650
Mailing Address - Fax:
Practice Address - Street 1:17372 SW LAWTON ST APT 206
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-7614
Practice Address - Country:US
Practice Address - Phone:360-710-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR136595146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic