Healthcare Provider Details

I. General information

NPI: 1801962337
Provider Name (Legal Business Name): NIDHI ANNA CHABORA APRN-RX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-3380 MAMANE ST SUITE #4
HONOKAA HI
96727-6933
US

IV. Provider business mailing address

PO BOX 1400
HONOKAA HI
96727-1400
US

V. Phone/Fax

Practice location:
  • Phone: 808-775-8835
  • Fax: 808-775-8834
Mailing address:
  • Phone: 808-775-8835
  • Fax: 808-775-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-RX 140
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: