Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1675 | HI |
NPI | 1003246513 |
---|---|
Provider Name | Mrs. Katie Akiko Azama |
First Address | Honolulu, HI 96825-3186 |
Second Address | Honolulu, HI 96816-5319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 19/11/2013 |