Provider Demographics
NPI:1457949240
Name:RODRIGUES NOSAKA, JOHNALYN KEKAIHOKULANI
Entity Type:Individual
Prefix:
First Name:JOHNALYN
Middle Name:KEKAIHOKULANI
Last Name:RODRIGUES NOSAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27-2461 KAHALA PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2278
Mailing Address - Country:US
Mailing Address - Phone:808-960-4163
Mailing Address - Fax:
Practice Address - Street 1:305 WAILUKU DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2488
Practice Address - Country:US
Practice Address - Phone:808-960-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-43078364SS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SS0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistSchool