Provider Demographics
NPI:1063727436
Name:NAKAMURA, DEANNA N (RD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:N
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-1347 KALANIANA'OLE HWY
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795
Mailing Address - Country:US
Mailing Address - Phone:808-259-7948
Mailing Address - Fax:808-259-6449
Practice Address - Street 1:41-1347 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:808-259-6449
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227294133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227294OtherCERTIFICATION NUMBER