Provider Demographics
NPI:1053461947
Name:KINOSHITA, LORI (FNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MA'A ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3603
Mailing Address - Country:US
Mailing Address - Phone:808-877-2020
Mailing Address - Fax:808-877-6060
Practice Address - Street 1:169 MA'A ST.
Practice Address - Street 2:SUITE B
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3603
Practice Address - Country:US
Practice Address - Phone:808-877-2020
Practice Address - Fax:808-877-6060
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI071290-01Medicare ID - Type Unspecified
HI51981Medicare ID - Type Unspecified
HIS87649Medicare UPIN