Provider Demographics
NPI:1891947669
Name:LUO-SOUZA, MACEY MIN-CHU (APRN-RX)
Entity Type:Individual
Prefix:MS
First Name:MACEY
Middle Name:MIN-CHU
Last Name:LUO-SOUZA
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:MS
Other - First Name:MACEY
Other - Middle Name:MIN-CHU
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APRN
Mailing Address - Street 1:1315 KALAKAUA AVE
Mailing Address - Street 2:APT 1809
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1943
Mailing Address - Country:US
Mailing Address - Phone:808-383-2644
Mailing Address - Fax:
Practice Address - Street 1:1315 KALAKAUA AVE
Practice Address - Street 2:APT 1809
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1943
Practice Address - Country:US
Practice Address - Phone:808-383-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1509364SP0807X
HIRN-59164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse