Provider Demographics
NPI:1235521691
Name:DE AQUINO, ROSALIE (LPN)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:DE AQUINO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-150 LUALEI PLACE
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:808-343-0311
Mailing Address - Fax:808-772-4016
Practice Address - Street 1:87-150 LUALEI PL
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3652
Practice Address - Country:US
Practice Address - Phone:808-343-0311
Practice Address - Fax:808-772-4016
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-150004172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker