Provider Demographics
NPI:1558413344
Name:NAKAGAWA, RAENELL R (RD)
Entity Type:Individual
Prefix:
First Name:RAENELL
Middle Name:R
Last Name:NAKAGAWA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:RAENELL
Other - Middle Name:K
Other - Last Name:REYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 3088
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96802-3088
Mailing Address - Country:US
Mailing Address - Phone:808-222-0965
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD
Practice Address - Street 2:STE 420 - CKD SERVICES OF PEARLRIDGE
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4777
Practice Address - Country:US
Practice Address - Phone:808-440-4800
Practice Address - Fax:808-440-4827
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI814076133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI102494Medicare UPIN