Provider Demographics
NPI:1174816136
Name:NAKAMURA, LISA K (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 KANU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1522
Mailing Address - Country:US
Mailing Address - Phone:808-728-3013
Mailing Address - Fax:808-836-1490
Practice Address - Street 1:1580 MAKALOA ST STE 880
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3258
Practice Address - Country:US
Practice Address - Phone:808-728-3013
Practice Address - Fax:808-836-1490
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT11361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist