Healthcare Provider Details

I. General information

NPI: 1629471834
Provider Name (Legal Business Name): NAOMI FUKUDA APRN-RX, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2135 FORT WEAVER RD SUITE 180
EWA BEACH HI
96706-3607
US

IV. Provider business mailing address

91-2135 FORT WEAVER RD SUITE 180
EWA BEACH HI
96706-3607
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-3370
  • Fax:
Mailing address:
  • Phone: 808-691-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN-26851
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAPRN-4
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: