Provider Demographics
NPI:1043218217
Name:CHRYSLER, NICOLE S (PA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:CHRYSLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N KALAHEO AVE STE C306
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1873
Mailing Address - Country:US
Mailing Address - Phone:808-263-7383
Mailing Address - Fax:808-237-5828
Practice Address - Street 1:970 N KALAHEO AVE STE C306
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1873
Practice Address - Country:US
Practice Address - Phone:808-263-7383
Practice Address - Fax:808-237-5828
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-447363A00000X
IDPA431363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID80695700Medicaid
ID80695700Medicaid
1665969Medicare ID - Type Unspecified