MEDICARE: MARTHA EVA NAKAMURA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	498953	NY
2	367500000X	Certified Registered Nurse Anesthetist	R191149	MD

General Provider Information

NPI Number	:	1245273564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA EVA NAKAMURA CRNA

Provider Business Mailing Address
First Line	:	13523 BARRETT PARKWAY DRIVE
Second Line	:	SUITE 104
City	:	BALLWIN
State	:	MO
Zip	:	63021-3802
Country	:	US
Telephone Number	:	636-938-6868
Fax Number	:	636-938-1486

Provider Business Practice Location Address
First Line	:	45 THOMAS JOHNSON DR.
Second Line	:	SUITE 207
City	:	FREDERICK
State	:	MD
Zip	:	21702-4425
Country	:	US
Telephone Number	:	301-694-3400
Fax Number	:	301-694-3620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/07/2011

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