Provider Demographics
NPI:1073759882
Name:CROWDER, VICKY MARQUEZ (APRN-RX)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:MARQUEZ
Last Name:CROWDER
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:BULLECER
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-RX
Mailing Address - Street 1:555 S. BERETANIA ST
Mailing Address - Street 2:STE 601
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-691-8900
Mailing Address - Fax:808-691-8919
Practice Address - Street 1:555 S. BERETANIA ST
Practice Address - Street 2:STE 601
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-691-8900
Practice Address - Fax:808-691-8919
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 1055363LA2100X
HIAPRN1055363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care