Provider Demographics
NPI:1245273564
Name:NAKAMURA, MARTHA EVA (CRNA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:EVA
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:636-938-6868
Mailing Address - Fax:636-938-1486
Practice Address - Street 1:45 THOMAS JOHNSON DR.
Practice Address - Street 2:SUITE 207
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4425
Practice Address - Country:US
Practice Address - Phone:301-694-3400
Practice Address - Fax:301-694-3620
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498953163W00000X
MDR191149367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse