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General NPI Number Information
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NPI Number | 1619521697
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Entity Type | Individual
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Provider Name | DIANNA FULTZ
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 27-330 MAMALAHOA HWY
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City | PAPAIKOU
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State | HI
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Zip | 96781
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Country | US
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Telephone | 808-964-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 11-3765 FIRST ST. BOX 806
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City | VOLCANO
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State | HI
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Zip | 96785
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Country | US
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Telephone | 502-542-0487
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 91311
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License Number State | HI
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