Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | APRN3122 | HI |
NPI | 1033883889 |
---|---|
Provider Name | Leilani Ludviksen |
First Address | Honolulu, HI 96825-1335 |
Second Address | Honolulu, HI 96825-1335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |