Provider Demographics
NPI:1164087078
Name:RICHARD, LAURA RENAE (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENAE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RENAE
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2620 DATE ST APT C5
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-5612
Mailing Address - Country:US
Mailing Address - Phone:808-216-3384
Mailing Address - Fax:
Practice Address - Street 1:2620 DATE ST APT C5
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-5612
Practice Address - Country:US
Practice Address - Phone:808-216-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI77951163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool