Provider Demographics
NPI:1477765543
Name:ANCHETA, KATHLEEN A (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:ANCHETA
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 1:53 S PUUNENE AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2121
Mailing Address - Country:US
Mailing Address - Phone:808-871-5144
Mailing Address - Fax:808-877-2430
Practice Address - Street 1:53 S PUUNENE AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2121
Practice Address - Country:US
Practice Address - Phone:808-871-5144
Practice Address - Fax:808-877-2430
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-28445163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000250514OtherHMSA PROVIDER NUMBER
HIRN-28445OtherSTATE LICENSURE
0921-3005OtherCDE CERTIFICATION