Doctor Name: | NICHOLE REYES |
NPI Number: | 1134501687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1877 |
Business Practice Address: | 1245 Kuala St Suite 103 Pearl City, HI - 967823900 |
Business Phone Number: | 8084562273 |
Business Fax Number: | |
Mailing Address: | 1245 Kuala St, Ste 103, PEARL CITY |
State: | HI |
Postal Code: | 967823900 |
Phone Number: | 8084562273 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2015 |
NPI Last Update Date: | 10/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 1877 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |