Provider Demographics
NPI:1578863924
Name:ROVA, CHEROKEE ROSE LEE (PAC)
Entity Type:Individual
Prefix:
First Name:CHEROKEE
Middle Name:ROSE LEE
Last Name:ROVA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4488 HANALEI PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-5462
Mailing Address - Country:US
Mailing Address - Phone:808-320-7300
Mailing Address - Fax:
Practice Address - Street 1:4488 HANALEI PLANTATION RD
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722-5462
Practice Address - Country:US
Practice Address - Phone:808-320-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-1104363A00000X
MN11206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1578863924Medicaid
MN1578863924Medicaid
MT1578863924Medicaid
MTM011000405Medicare PIN