MEDICARE: KRISTINA MARIE VIRATA HALLORAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	345210	NY
2	363LF0000X	Family Nurse Practitioner	2769	HI

General Provider Information

NPI Number	:	1063062834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE VIRATA HALLORAN APRN

Provider Business Mailing Address
First Line	:	99-128 AIEA HEIGHTS DR STE 703
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3978
Country	:	US
Telephone Number	:	808-487-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	99-128 AIEA HEIGHTS DR STE 703
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3978
Country	:	US
Telephone Number	:	808-487-7938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	07/31/2020

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