Healthcare Provider Details

I. General information

NPI: 1437474103
Provider Name (Legal Business Name): SHASHIMA NAKAHARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2730
  • Fax: 360-414-2739
Mailing address:
  • Phone: 360-414-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD177193
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60650945
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPG171439
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: