Provider Demographics
NPI:1134527245
Name:GRANDA, MARQUITA (MSN, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:GRANDA
Suffix:
Gender:F
Credentials:MSN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5972 HEAMOI PL
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-9704
Mailing Address - Country:US
Mailing Address - Phone:808-722-7710
Mailing Address - Fax:
Practice Address - Street 1:5972 HEAMOI PL
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-9704
Practice Address - Country:US
Practice Address - Phone:808-722-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60733123363LF0000X
HIAPRN1837363LP0808X, 363LP2300X
OR201603089NP-PP363LF0000X
OR202009723NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500709520Medicaid
ORR189116Medicare PIN
ORR191097Medicare PIN
ORR191096Medicare PIN
ORR189115Medicare PIN
ORR191095Medicare PIN
ORR191094Medicare PIN