Provider Demographics
NPI:1346339462
Name:ZICK-MARITERAGI, LISA LYN (APRN-RX, MSN, MPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYN
Last Name:ZICK-MARITERAGI
Suffix:
Gender:F
Credentials:APRN-RX, MSN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:86-260 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3128
Mailing Address - Country:US
Mailing Address - Phone:808-697-3490
Mailing Address - Fax:808-696-6604
Practice Address - Street 1:86-260 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3128
Practice Address - Country:US
Practice Address - Phone:808-697-3490
Practice Address - Fax:808-696-6604
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN:31132/APRN:224/RX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52631101Medicaid
HI52631101Medicaid
HIS25148Medicare UPIN