Provider Demographics
NPI:1043802317
Name:FUENTES, KRISTIA LEANNE (APRN-RX)
Entity Type:Individual
Prefix:
First Name:KRISTIA LEANNE
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:KRISTIA LEANNE
Other - Middle Name:
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-RX
Mailing Address - Street 1:94-745 MEHEULA PKWY APT 18C
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4021
Mailing Address - Country:US
Mailing Address - Phone:206-372-1484
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-206-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner