=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083454474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORIE ANN MADARIAGA RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2024
-----------------------------------------------------
Last Update Date | 05/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 PATTERSON RD
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-433-6445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 459 PATTERSON RD
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-433-6445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0500X
-----------------------------------------------------
Taxonomy Name | Hemodialysis Registered Nurse
-----------------------------------------------------
License Number | RN-67540
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------