Provider Demographics
NPI:1669961322
Name:DAVID, MICAH (FNP-C)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 NUUANU AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5193
Mailing Address - Country:US
Mailing Address - Phone:808-379-0428
Mailing Address - Fax:808-320-6647
Practice Address - Street 1:928 NUUANU AVE STE 104
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5193
Practice Address - Country:US
Practice Address - Phone:808-379-0428
Practice Address - Fax:808-320-6647
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty