Provider Demographics
NPI:1144578840
Name:HOUGHTALING, DENISE LAVONNE (MSN,APRN,FNE,SANE-A,)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LAVONNE
Last Name:HOUGHTALING
Suffix:
Gender:F
Credentials:MSN,APRN,FNE,SANE-A,
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Other - Middle Name:
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Mailing Address - Street 1:15-1817 LAAMIA AVE
Mailing Address - Street 2:15-1817 14TH ST
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749
Mailing Address - Country:US
Mailing Address - Phone:808-966-5015
Mailing Address - Fax:
Practice Address - Street 1:15-1817 LAAMIA AVE
Practice Address - Street 2:15-1817 14TH ST
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-7116
Practice Address - Country:US
Practice Address - Phone:808-966-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN 1079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily