MEDICARE: REINA NAGASAKA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1225840051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REINA NAGASAKA

Provider Business Mailing Address
First Line	:	3333 GREEN BAY RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3037
Country	:	US
Telephone Number	:	847-578-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 N PINE AVE APT 305
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6176
Country	:	US
Telephone Number	:	847-345-9532
Fax Number	:

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

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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