Provider Demographics
NPI:1629627112
Name:NAKAMURA, EMIKO N/A I (LMP)
Entity Type:Individual
Prefix:
First Name:EMIKO
Middle Name:N/A
Last Name:NAKAMURA
Suffix:I
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 MALTBY RD UNIT D107
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7460
Mailing Address - Country:US
Mailing Address - Phone:425-215-5686
Mailing Address - Fax:
Practice Address - Street 1:800 164TH ST SE STE O
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-737-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006215225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty