Provider Demographics
NPI:1407230006
Name:NAKAMURA, NICOLE (MA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NAKAMURA
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 KILOU ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-9751
Mailing Address - Country:US
Mailing Address - Phone:815-703-4387
Mailing Address - Fax:
Practice Address - Street 1:1238 KILOU ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9751
Practice Address - Country:US
Practice Address - Phone:815-703-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0015139101YM0800X
HIMHC-783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health