Provider Demographics
NPI:1790840627
Name:NAKAMURA, MICHAEL K (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:NAKAMURA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 E VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7910
Mailing Address - Country:US
Mailing Address - Phone:928-699-5927
Mailing Address - Fax:928-526-9472
Practice Address - Street 1:4140 E VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7910
Practice Address - Country:US
Practice Address - Phone:928-699-5927
Practice Address - Fax:928-526-9472
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN128597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse