Provider Demographics
NPI:1114706207
Name:KIDA, ANDIE
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:
Last Name:KIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDIE
Other - Middle Name:
Other - Last Name:KIDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC, RD
Mailing Address - Street 1:970 N KALAHEO AVE STE C306
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1873
Mailing Address - Country:US
Mailing Address - Phone:808-263-7383
Mailing Address - Fax:808-327-5828
Practice Address - Street 1:970 N KALAHEO AVE STE C306
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1873
Practice Address - Country:US
Practice Address - Phone:808-398-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI86065727133V00000X
HI99400163W00000X
HIAPRN-4259-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse