Provider Demographics
NPI:1710282157
Name:COLOME, NATALIE
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:COLOME
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 1:89 HOOKELE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3532
Mailing Address - Country:US
Mailing Address - Phone:808-871-8878
Mailing Address - Fax:808-871-8867
Practice Address - Street 1:89 HOOKELE ST STE 103
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3532
Practice Address - Country:US
Practice Address - Phone:808-871-8878
Practice Address - Fax:808-871-8867
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant