Provider Demographics
NPI:1588189799
Name:WAHAB, MARIA CARDONA (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARDONA
Last Name:WAHAB
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-366-6300
Mailing Address - Fax:808-433-9025
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-366-6300
Practice Address - Fax:808-433-9025
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI77256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA675108OtherREGISTERED NURSE LICENSE
HI77256OtherREGISTERED NURSE LICENSE
AL1-172186OtherREGISTERED NURSE LICENSE