Healthcare Provider Details

I. General information

NPI: 1639592439
Provider Name (Legal Business Name): IKUKO NAKANO MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 S ORCAS ST
SEATTLE WA
98118-2431
US

IV. Provider business mailing address

34617 11TH PL S #104
FEDERAL WAY WA
98003-8706
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-9908
  • Fax: 206-760-8013
Mailing address:
  • Phone: 253-874-8445
  • Fax: 253-874-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60315332
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: