Provider Demographics
NPI:1558872135
Name:PATEL, PALLAVIKA CHANDUBHAI (APRN)
Entity Type:Individual
Prefix:MS
First Name:PALLAVIKA
Middle Name:CHANDUBHAI
Last Name:PATEL
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 1:612 KAUMAKA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2411
Mailing Address - Country:US
Mailing Address - Phone:808-255-3869
Mailing Address - Fax:
Practice Address - Street 1:1022 GULICK AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4511
Practice Address - Country:US
Practice Address - Phone:808-847-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner