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NPI Code Detail

MEDICARE: CONNIE J WALSTROM FNP

MEDICARE:   CONNIE J WALSTROM  FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1605HI
2363LF0000XFamily Nurse Practitioner584968TX

General Provider Information

NPI Number : 1093728545
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE J WALSTROM FNP
Provider Business Mailing Address
First Line : 2239 N SCHOOL ST
Second Line :
City : HONOLULU
State : HI
Zip : 96819-2539
Country : US
Telephone Number : 808-791-9400
Fax Number : 808-847-6051
Provider Business Practice Location Address
First Line : 2239 N SCHOOL ST
Second Line :
City : HONOLULU
State : HI
Zip : 96819-2539
Country : US
Telephone Number : 808-791-9400
Fax Number : 808-847-6051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 03/17/2020

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Directions to “ CONNIE J WALSTROM FNP” Practice Location

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