Provider Demographics
NPI:1346778354
Name:CHUCK, ALIA NICOLE
Entity Type:Individual
Prefix:MS
First Name:ALIA
Middle Name:NICOLE
Last Name:CHUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2499
Mailing Address - Country:US
Mailing Address - Phone:808-691-1000
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2499
Practice Address - Country:US
Practice Address - Phone:808-691-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-03
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD1052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant