Provider Demographics
NPI:1649236050
Name:HOUSE, JOHN L (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:HOUSE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S BERETANIA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2423
Mailing Address - Country:US
Mailing Address - Phone:808-691-8877
Mailing Address - Fax:808-691-8875
Practice Address - Street 1:550 S BERETANIA ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2423
Practice Address - Country:US
Practice Address - Phone:808-691-8877
Practice Address - Fax:808-691-8875
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165274363LF0000X
HIAPRN-2936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007792778Medicaid
VA007792778Medicaid