Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN - 742 | HI |
NPI | 1013083211 |
---|---|
Provider Name | Paula Vickery |
First Address | Hilo, HI 96720-5590 |
Second Address | Hilo, HI 96720-4293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000247171 | HMSA (01) | HI |
0000551798 | (05) | HI |
Q35320 | (02) | HI |