Provider Demographics
NPI:1013791623
Name:ALDER, MADE R
Entity type:Individual
Prefix:
First Name:MADE
Middle Name:R
Last Name:ALDER
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 1:642 ULUKAHIKI ST STE 209
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4439
Mailing Address - Country:US
Mailing Address - Phone:808-230-8500
Mailing Address - Fax:808-230-8501
Practice Address - Street 1:642 ULUKAHIKI ST STE 209
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4439
Practice Address - Country:US
Practice Address - Phone:808-230-8500
Practice Address - Fax:808-230-8501
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF08230808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily