Healthcare Provider Details

I. General information

NPI: 1235331968
Provider Name (Legal Business Name): MARIE DIANNE FOCHTMAN SELENY APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M DIANNE FOCHTMAN APRN, CPNP

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8676
  • Fax: 808-983-8005
Mailing address:
  • Phone: 808-983-8676
  • Fax: 808-983-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number427
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number186
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number38274
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: