Provider Demographics
NPI:1184220493
Name:LEDDA, EUFROCINA A (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:EUFROCINA
Middle Name:A
Last Name:LEDDA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 KUPAU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3639
Mailing Address - Country:US
Mailing Address - Phone:808-263-4154
Mailing Address - Fax:808-263-4154
Practice Address - Street 1:1026 KUPAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3639
Practice Address - Country:US
Practice Address - Phone:808-263-4154
Practice Address - Fax:808-263-4154
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI787018Medicaid