Provider Demographics
NPI:1174637474
Name:SOTO, DEBRA DYANNE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DYANNE
Last Name:SOTO
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 MANONO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2211
Mailing Address - Country:US
Mailing Address - Phone:808-429-5447
Mailing Address - Fax:
Practice Address - Street 1:528 MED DET (CSC)
Practice Address - Street 2:COB SPEICHER, IRAQ
Practice Address - City:COB SPEICHER
Practice Address - State:APO AE
Practice Address - Zip Code:09393
Practice Address - Country:IQ
Practice Address - Phone:318-845-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37700163WP0809X
HIAPRN 99364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult