Provider Demographics
NPI:1114459153
Name:NAKAMURA, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
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 1:3325 N NELLIS BLVD TRLR 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2845
Mailing Address - Country:US
Mailing Address - Phone:702-980-8742
Mailing Address - Fax:
Practice Address - Street 1:3620 N RANCHO DR
Practice Address - Street 2:SUITE107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3155
Practice Address - Country:US
Practice Address - Phone:702-656-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner