Provider Demographics
NPI:1629279716
Name:STARK, MARIAILIANA J (DRPH, RN,APRN,CPNP)
Entity Type:Individual
Prefix:DR
First Name:MARIAILIANA
Middle Name:J
Last Name:STARK
Suffix:
Gender:F
Credentials:DRPH, RN,APRN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 B HUNNEWELL STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822
Mailing Address - Country:US
Mailing Address - Phone:808-947-9009
Mailing Address - Fax:
Practice Address - Street 1:2002 B HUNNEWELL STREET
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-947-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 260363L00000X
HIRN 23131364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000221481OtherHMSA
HI55177201Medicaid
HI0000221481OtherHMSA
HI55177201Medicaid