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NPI Code Detail

MEDICARE: DIANA JEAN DEBERNARDO

MEDICARE: DIANA JEAN DEBERNARDO
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
1363L00000XNurse Practitioner12.010066CT
2363L00000XNurse PractitionerAPRN-4363HI

General Provider Information

NPI Number : 1578235578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA JEAN DEBERNARDO
Provider Business Mailing Address
First Line : 307 PROSPECT ST APT 4
Second Line :
City : HONOLULU
State : HI
Zip : 96813-1802
Country : US
Telephone Number : 203-922-2898
Fax Number :
Provider Business Practice Location Address
First Line : 860 IWILEI RD
Second Line :
City : HONOLULU
State : HI
Zip : 96817-5018
Country : US
Telephone Number : 808-924-9255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2021
Last Update Date : 07/10/2024

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Directions to “ DIANA JEAN DEBERNARDO ” Practice Location

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