Provider Demographics
NPI:1578330593
Name:KAMENAR, ELLEN NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:NICOLE
Last Name:KAMENAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 LAULOA ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7015
Mailing Address - Country:US
Mailing Address - Phone:513-324-0382
Mailing Address - Fax:
Practice Address - Street 1:34 WAILEA GATEWAY PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6525
Practice Address - Country:US
Practice Address - Phone:808-501-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4142363LF0000X
HI4142363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily