Provider Demographics
NPI:1457604316
Name:TABALNO, MARISA J (NP)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:J
Last Name:TABALNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:J
Other - Last Name:MOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:98-1079 MOANALUA RD STE 630
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4721
Mailing Address - Country:US
Mailing Address - Phone:808-485-5414
Mailing Address - Fax:808-485-3022
Practice Address - Street 1:3-3420 KUHIO HWY STE B
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1098
Practice Address - Country:US
Practice Address - Phone:808-245-1500
Practice Address - Fax:808-246-1391
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner