Provider Demographics
NPI:1073510202
Name:BROAD, LAURIANN MAHEALANI (FNPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIANN
Middle Name:MAHEALANI
Last Name:BROAD
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-558 AWAPAPA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1923
Mailing Address - Country:US
Mailing Address - Phone:808-433-8690
Mailing Address - Fax:808-433-8694
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:COMMUNITY HEALTH NURSING
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96759-5000
Practice Address - Country:US
Practice Address - Phone:808-433-6890
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care