Provider Demographics
NPI:1063062834
Name:HALLORAN, KRISTINA MARIE VIRATA (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE VIRATA
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR STE 703
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3978
Mailing Address - Country:US
Mailing Address - Phone:808-487-7938
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 703
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3978
Practice Address - Country:US
Practice Address - Phone:808-487-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345210363LF0000X
HI2769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily