Provider Demographics
NPI:1225668551
Name:NAKAO, KATRINA KYOKO
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:KYOKO
Last Name:NAKAO
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 1:3510 CHEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1241
Mailing Address - Country:US
Mailing Address - Phone:202-503-9680
Mailing Address - Fax:202-688-5587
Practice Address - Street 1:3510 CHEVERLY AVE
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1241
Practice Address - Country:US
Practice Address - Phone:202-503-9680
Practice Address - Fax:202-688-5587
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDEM00023176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife