Provider Demographics
NPI:1255947685
Name:ALDAG, CARLY PAIGE (FNP, BC)
Entity type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:PAIGE
Last Name:ALDAG
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AULIKE ST APT 804
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2744
Mailing Address - Country:US
Mailing Address - Phone:920-946-9110
Mailing Address - Fax:
Practice Address - Street 1:14 AULIKE ST APT 804
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2744
Practice Address - Country:US
Practice Address - Phone:920-946-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-92401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily