Provider Demographics
NPI:1518604149
Name:FURSEY, WIMONRAT (APRN)
Entity Type:Individual
Prefix:
First Name:WIMONRAT
Middle Name:
Last Name:FURSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S BERETANIA ST STE C211C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2222
Mailing Address - Country:US
Mailing Address - Phone:808-532-2020
Mailing Address - Fax:808-674-8936
Practice Address - Street 1:50 S BERETANIA ST STE C211C
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2222
Practice Address - Country:US
Practice Address - Phone:808-532-2020
Practice Address - Fax:808-674-8936
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3655-0363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health