Provider Demographics
NPI:1255638102
Name:FAIRFAX, LORI L (NP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:FAIRFAX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:BORZA, REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-973-8673
Mailing Address - Fax:808-973-6392
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-973-8673
Practice Address - Fax:808-973-6392
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1332363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal