Provider Demographics
NPI:1629471834
Name:FUKUDA, NAOMI (APRN-RX, CDE)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:FUKUDA
Suffix:
Gender:F
Credentials:APRN-RX, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2135 FORT WEAVER RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3607
Mailing Address - Country:US
Mailing Address - Phone:808-691-3370
Mailing Address - Fax:
Practice Address - Street 1:91-2135 FORT WEAVER RD
Practice Address - Street 2:SUITE 180
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3607
Practice Address - Country:US
Practice Address - Phone:808-691-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-26851163WD0400X
HIAPRN-4364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator