=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801962337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIDHI ANNA CHABORA APRN-RX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45-3380 MAMANE ST SUITE #4
-----------------------------------------------------
City | HONOKAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96727-6933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-775-8835
-----------------------------------------------------
Fax | 808-775-8834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1400
-----------------------------------------------------
City | HONOKAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96727-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-775-8835
-----------------------------------------------------
Fax | 808-775-8834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN-RX 140
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------