Basic Information
| Provider Information | |||||||||
| NPI: | 1245273564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAKAMURA | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | EVA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13523 BARRETT PARKWAY DRIVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630213802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369386868 | ||||||||
| FaxNumber: | 6369381486 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 THOMAS JOHNSON DR. | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016943400 | ||||||||
| FaxNumber: | 3016943620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 498953 | NY | N | Nursing Service Providers | Registered Nurse | 367500000X | R191149 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.