Provider Demographics
NPI:1417460635
Name:TALI, GLENDA FAYE (PHD, RN, APRN)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:FAYE
Last Name:TALI
Suffix:
Gender:F
Credentials:PHD, RN, APRN
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:FAYE
Other - Last Name:GOBLE, MOORE, NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:1345 S BERETANIA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1802
Mailing Address - Country:US
Mailing Address - Phone:808-744-2543
Mailing Address - Fax:866-451-4608
Practice Address - Street 1:1345 S BERETANIA ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1802
Practice Address - Country:US
Practice Address - Phone:808-744-2543
Practice Address - Fax:866-451-4608
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1225363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health