Provider Demographics
NPI:1588067227
Name:NAMBA, YUSUKE
Entity type:Individual
Prefix:MR
First Name:YUSUKE
Middle Name:
Last Name:NAMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 CAPITOL CT. APT 872
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132
Mailing Address - Country:US
Mailing Address - Phone:402-201-7068
Mailing Address - Fax:
Practice Address - Street 1:7070 CAPITOL COURT APT 872
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132
Practice Address - Country:US
Practice Address - Phone:402-201-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program