Provider Demographics
NPI:1679104988
Name:EDRA, DARCIE YUKIE
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:YUKIE
Last Name:EDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-510 WIKAO ST APT F206
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5009
Mailing Address - Country:US
Mailing Address - Phone:808-354-6816
Mailing Address - Fax:
Practice Address - Street 1:95-510 WIKAO ST APT F206
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-5009
Practice Address - Country:US
Practice Address - Phone:808-354-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion