Provider Demographics
NPI:1063433498
Name:KUKEL, DENIELLE (PA)
Entity type:Individual
Prefix:
First Name:DENIELLE
Middle Name:
Last Name:KUKEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DENIELLE
Other - Middle Name:
Other - Last Name:SARACINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1301 PUNCHBOWL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-537-7143
Mailing Address - Fax:808-537-7496
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-537-7143
Practice Address - Fax:808-537-7496
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016404363A00000X
CT001645363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1063433498OtherNPI
RI939025129OtherMEDICARE GROUP NUMBER
RI1063433498OtherNPI
RI939025129OtherMEDICARE GROUP NUMBER