Provider Demographics
NPI:1609240712
Name:MARK, ANELLA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANELLA
Middle Name:
Last Name:MARK
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 1:39 W KAMEHAMEHA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2263
Mailing Address - Country:US
Mailing Address - Phone:808-877-2424
Mailing Address - Fax:
Practice Address - Street 1:39 W KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2031363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care