| Doctor Name: | MR. NICHOLAS ALEXANDER PUKISH |
| NPI Number: | 1073539771 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA 9100880 |
| Business Practice Address: | 480 Central Ave Naval Health Clinic Hawaii Jbphh, HI - 968604908 |
| Business Phone Number: | 8084772600 |
| Business Fax Number: | |
| Mailing Address: | 4950 Catalina Ln, HONOLULU |
| State: | HI |
| Postal Code: | 968185077 |
| Phone Number: | 8082255878 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 02/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA 9100880 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |