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General NPI Number Information
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NPI Number | 1114536448
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Entity Type | Individual
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Provider Name | JOANNA MARIE FIDEL PLUMB FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 2180 MAIN ST
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City | WAILUKU
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State | HI
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Zip | 96793-1625
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Country | US
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Telephone | 808-242-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 MAIN ST
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City | WAILUKU
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State | HI
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Zip | 96793-1625
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Country | US
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Telephone | 808-242-6464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28009
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-4059
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License Number State | HI
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