Provider Demographics
NPI:1609073345
Name:NAKAMOTO, DEANNE MICHIKO (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:MICHIKO
Last Name:NAKAMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEANNE
Other - Middle Name:NAKAMOTO
Other - Last Name:FARACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3260 NW MOUNT VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6000
Mailing Address - Country:US
Mailing Address - Phone:360-698-9500
Mailing Address - Fax:360-698-9900
Practice Address - Street 1:3260 NW MOUNT VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6000
Practice Address - Country:US
Practice Address - Phone:360-698-9500
Practice Address - Fax:360-698-9900
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60158450207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0093NAOtherREGENCE
WA1609073345Medicaid