Provider Demographics
NPI:1730217050
Name:NAGASHIMA, OLIVIA B (LMT)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:B
Last Name:NAGASHIMA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HUALANI ST APT C
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2285
Mailing Address - Country:US
Mailing Address - Phone:808-255-5234
Mailing Address - Fax:808-255-5234
Practice Address - Street 1:46-005 KAWA ST STE 306
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3813
Practice Address - Country:US
Practice Address - Phone:808-255-5234
Practice Address - Fax:808-255-5234
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 4314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI487761400OtherADP PROVIDER NO.
HI1043289OtherASHN PROVIDER NO.