Provider Demographics
NPI:1679292296
Name:PONTE, MATTY SLOAN (APRN)
Entity Type:Individual
Prefix:
First Name:MATTY
Middle Name:SLOAN
Last Name:PONTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MATTY
Other - Middle Name:SLOAN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1830 WELLS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2365
Mailing Address - Country:US
Mailing Address - Phone:808-856-4060
Mailing Address - Fax:808-442-9670
Practice Address - Street 1:1830 WELLS ST STE 101
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2365
Practice Address - Country:US
Practice Address - Phone:808-856-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3763-0363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care