Provider Demographics
NPI:1235696741
Name:ROBERTS, DIVYA REBECCA (CRNP)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:REBECCA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 LAUKAHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2619
Mailing Address - Country:US
Mailing Address - Phone:716-200-9457
Mailing Address - Fax:
Practice Address - Street 1:55 MERCHANT ST STE 2900
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4384
Practice Address - Country:US
Practice Address - Phone:808-536-8012
Practice Address - Fax:808-536-8013
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3612363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology