Provider Demographics
NPI:1417507229
Name:MORALES, ANJULIE LYNE DAVID (RN)
Entity Type:Individual
Prefix:
First Name:ANJULIE
Middle Name:LYNE DAVID
Last Name:MORALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:NAALEHU
Mailing Address - State:HI
Mailing Address - Zip Code:96772-0509
Mailing Address - Country:US
Mailing Address - Phone:808-747-0355
Mailing Address - Fax:
Practice Address - Street 1:92-2466 OHIA DRIVE
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96737
Practice Address - Country:US
Practice Address - Phone:808-747-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI81224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse