Provider Demographics
NPI:1134347644
Name:NAKASHIMA, PENNIE MARIE
Entity type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:MARIE
Last Name:NAKASHIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PENNIE
Other - Middle Name:MARIE
Other - Last Name:KRYZWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5879 WOODFIELD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1865
Mailing Address - Country:US
Mailing Address - Phone:703-313-0808
Mailing Address - Fax:
Practice Address - Street 1:5879 WOODFIELD ESTATES DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1865
Practice Address - Country:US
Practice Address - Phone:703-313-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist