Provider Demographics
NPI:1972269991
Name:WONG, KAMOMILANI ANDUHA (PHD, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAMOMILANI
Middle Name:ANDUHA
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 ALA MAHAMOE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1765
Mailing Address - Country:US
Mailing Address - Phone:808-772-6825
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST STE 1555
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2073
Practice Address - Country:US
Practice Address - Phone:808-589-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN55102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily