Provider Demographics
NPI:1497394555
Name:DANNIBALE, ANNELISE
Entity Type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:DANNIBALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-997 HANAUNA ST # 5F
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4739
Mailing Address - Country:US
Mailing Address - Phone:469-307-8969
Mailing Address - Fax:
Practice Address - Street 1:94-997 HANAUNA ST # 5F
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4739
Practice Address - Country:US
Practice Address - Phone:469-307-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI95714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse