Provider Demographics
NPI:1649327230
Name:NAKAMOTO, RYANNE L V (NP)
Entity type:Individual
Prefix:
First Name:RYANNE
Middle Name:L V
Last Name:NAKAMOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RYANNE
Other - Middle Name:L
Other - Last Name:VIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99-902 MOANALUA RD
Mailing Address - Street 2:HALAWA CORRECTIONAL FACILITY
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3252
Mailing Address - Country:US
Mailing Address - Phone:808-485-5186
Mailing Address - Fax:
Practice Address - Street 1:99-902 MOANALUA RD
Practice Address - Street 2:HALAWA CORRECTIONAL FACILITY
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3252
Practice Address - Country:US
Practice Address - Phone:808-485-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53685706Medicaid
HI00C0240543OtherHMSA BILLING NUMBER
HIP87007Medicare UPIN
HIH100525Medicare PIN