Provider Demographics
NPI:1376107953
Name:FULLER-TANAKA, ALANA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:FULLER-TANAKA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-550 KENEKE PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3420
Mailing Address - Country:US
Mailing Address - Phone:808-436-3629
Mailing Address - Fax:
Practice Address - Street 1:45-550 KENEKE PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3420
Practice Address - Country:US
Practice Address - Phone:808-436-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI91112163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse