Provider Demographics
NPI:1265912331
Name:SOUZA, LEESA (FNP)
Entity type:Individual
Prefix:
First Name:LEESA
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328B KAWAINUI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2487
Mailing Address - Country:US
Mailing Address - Phone:808-497-0544
Mailing Address - Fax:
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 314
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3724
Practice Address - Country:US
Practice Address - Phone:808-234-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily