Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN-2521 | HI |
NPI | 1013943455 |
---|---|
Provider Name | Ms. Nicole Louise Hodgeboom |
First Address | Honolulu, HI 96814-1874 |
Second Address | Honolulu, HI 96814-1874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 12/06/2019 |