1598008849 NPI number — VICTORIA DENNIS FNP-BC

Table of content: VICTORIA DENNIS FNP-BC (NPI 1598008849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598008849 NPI number — VICTORIA DENNIS FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNIS
Provider First Name:
VICTORIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598008849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 KAMEHAMEHA V HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAUNAKAKAI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-553-9080
Provider Business Mailing Address Fax Number:
808-553-3353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
691 MOPUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAIKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96708-5629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-553-9080
Provider Business Practice Location Address Fax Number:
808-553-3353
Provider Enumeration Date:
04/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1250 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2100X , with the licence number: 2009008937 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1250 . This is a "APRN 1250" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 361 . This is a "APRN PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: RN00150 . This is a "DEPARTMENT OF PUBLIC SAFETY, NARCOTIC ENFORCEMENT DIVISION" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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