Individual
COLLEEN NAKAMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2137 LAKESIDE DR, LYNCHBURG, VA 24501-6806
(434) 385-4184
(434) 385-8616
Mailing address
PO BOX 2489, #1, FOREST, VA 24551-6489
(434) 382-1139
(434) 525-5748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001810
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528155892
CVFP CORPORATE NPI
—
01
—
1972680049
CVFP SITE NPI
—
01
—
C03658
MEDICARE GROUP PTAN
—
Enumeration date
07/05/2006
Last updated
05/28/2008
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