Provider Demographics
NPI:1083959621
Name:MENDYKOWSKI, ALICE DEUTSCH (APRN)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:DEUTSCH
Last Name:MENDYKOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46-078 EMEPELA PL APT J201
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3960
Mailing Address - Country:US
Mailing Address - Phone:805-404-4859
Mailing Address - Fax:808-263-5054
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-263-5050
Practice Address - Fax:808-263-5054
Is Sole Proprietor?:No
Enumeration Date:2012-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1522363L00000X
HIAPRN-1522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner