Provider Demographics
NPI:1255678322
Name:NICOLAS, MONA D (CNA)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:D
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-174 KUPUNA LOOP
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1116
Mailing Address - Country:US
Mailing Address - Phone:808-677-1473
Mailing Address - Fax:
Practice Address - Street 1:94-174 KUPUNA LOOP
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1116
Practice Address - Country:US
Practice Address - Phone:808-677-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH1030303072376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide