Provider Demographics
NPI:1235331968
Name:FOCHTMAN SELENY, MARIE DIANNE (APRN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DIANNE
Last Name:FOCHTMAN SELENY
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:MS
Other - First Name:M
Other - Middle Name:DIANNE
Other - Last Name:FOCHTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, CPNP
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-983-8676
Mailing Address - Fax:808-983-8005
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-8676
Practice Address - Fax:808-983-8005
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI38274163WP0218X
HI427363LP0200X
HI186363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5695-2OtherSTATE PROVIDER NUMBER