Provider Demographics
NPI:1619976115
Name:MATTHEUS, DEBORAH J (PHD, MSN, PNP, APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MATTHEUS
Suffix:
Gender:F
Credentials:PHD, MSN, PNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HAHAIONE ST
Mailing Address - Street 2:12L
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45-710 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2947
Practice Address - Country:US
Practice Address - Phone:808-247-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 1011363LP0200X, 363LF0000X
FLARNP9203832363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHG847ZMedicare PIN
FL306832300Medicaid