Provider Demographics
NPI:1184026809
Name:WYKA, LIESL NOEL (NP)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:NOEL
Last Name:WYKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 LAAMIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1402
Mailing Address - Country:US
Mailing Address - Phone:719-466-0207
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE C316
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1883
Practice Address - Country:US
Practice Address - Phone:808-488-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991022NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily