Healthcare Provider Details

I. General information

NPI: 1245273564
Provider Name (Legal Business Name): MARTHA EVA NAKAMURA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 THOMAS JOHNSON DR. SUITE 207
FREDERICK MD
21702-4425
US

IV. Provider business mailing address

13523 BARRETT PARKWAY DRIVE SUITE 104
BALLWIN MO
63021-3802
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-3400
  • Fax: 301-694-3620
Mailing address:
  • Phone: 636-938-6868
  • Fax: 636-938-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number498953
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR191149
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: