Provider Demographics
NPI:1801612460
Name:SCHEFFELMAIER RYAN, KIMBERLY ROSA (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROSA
Last Name:SCHEFFELMAIER RYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ROSA
Other - Last Name:SCHEFFELMAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91-2036 KAIOLI ST APT 6202
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6080
Mailing Address - Country:US
Mailing Address - Phone:208-582-4263
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID74968163W00000X
HI111169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse