Healthcare Provider Details

I. General information

NPI: 1669009155
Provider Name (Legal Business Name): LORYTESS ABLAO SOLIVEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORYTESS DELA PENA ABLAO RN

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W HORIZON RIDGE PKWY STE 140
HENDERSON NV
89052-4395
US

IV. Provider business mailing address

32 KUUHALE PL
KAHULUI HI
96732-3130
US

V. Phone/Fax

Practice location:
  • Phone: 805-719-3700
  • Fax: 805-413-9099
Mailing address:
  • Phone: 808-633-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF01201868
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: