Provider Demographics
NPI:1639592439
Name:NAKANO, IKUKO (MSN, ARNP)
Entity Type:Individual
Prefix:MS
First Name:IKUKO
Middle Name:
Last Name:NAKANO
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34617 11TH PL S
Mailing Address - Street 2:#104
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8706
Mailing Address - Country:US
Mailing Address - Phone:253-874-8445
Mailing Address - Fax:253-874-2085
Practice Address - Street 1:4508 S ORCAS ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2431
Practice Address - Country:US
Practice Address - Phone:206-725-9908
Practice Address - Fax:206-760-8013
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60315332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily