Provider Demographics
NPI:1386669224
Name:PUGLIESE LOCKE, RANADA MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:RANADA
Middle Name:MARIE
Last Name:PUGLIESE LOCKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-445 CROZIER DR
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9303
Mailing Address - Country:US
Mailing Address - Phone:808-366-9726
Mailing Address - Fax:808-664-9129
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2747207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2462420Medicaid
CANA0027470OtherBS OF CA
CANA0027470OtherBS OF CA
CARN2462420Medicaid
CAZZZ02642ZMedicare PIN
HIH101792Medicare PIN