Provider Demographics
NPI:1811783582
Name:FORTE, MICHAEL LA JADE (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LA JADE
Last Name:FORTE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1051 FRANKLIN D ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2185
Mailing Address - Country:US
Mailing Address - Phone:808-458-5065
Mailing Address - Fax:808-461-6918
Practice Address - Street 1:91-1051 FRANKLIN D ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2185
Practice Address - Country:US
Practice Address - Phone:808-458-5065
Practice Address - Fax:808-461-6918
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI85371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse