Provider Demographics
NPI:1336695311
Name:SMITH, MISTY LILINOE N (DNP, APRN, NNP-BC)
Entity Type:Individual
Prefix:
First Name:MISTY LILINOE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, NNP-BC
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:L
Other - Last Name:HUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-1042 OKUPE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3552
Mailing Address - Country:US
Mailing Address - Phone:360-402-0777
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1080
Practice Address - Country:US
Practice Address - Phone:808-983-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3268363LN0000X
WAAP60803548363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal