Provider Demographics
NPI:1770223232
Name:MEDINA, CHERRY ELAINE SERAFICA (APRN)
Entity Type:Individual
Prefix:
First Name:CHERRY ELAINE
Middle Name:SERAFICA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 HALUPA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1819
Mailing Address - Country:US
Mailing Address - Phone:808-227-6627
Mailing Address - Fax:
Practice Address - Street 1:55 MERCHANT ST STE 2900
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4384
Practice Address - Country:US
Practice Address - Phone:808-536-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3568-0363LG0600X
HIAPRN3568-0363LG0600X
HIAPRN-3568-0363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology