Provider Demographics
NPI:1154290914
Name:KUWAMOTO-MCCREE, ICEIZ MERCAYDIEZ
Entity type:Individual
Prefix:
First Name:ICEIZ
Middle Name:MERCAYDIEZ
Last Name:KUWAMOTO-MCCREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 M ST APT 212
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1759
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:
Practice Address - Street 1:1824 M ST APT 212
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1759
Practice Address - Country:US
Practice Address - Phone:402-742-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion