Provider Demographics
NPI:1154346914
Name:FORONDA, ROSEMARIE (APRN)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:FORONDA
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 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1666
Mailing Address - Country:US
Mailing Address - Phone:808-242-6464
Mailing Address - Fax:808-243-2343
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1666
Practice Address - Country:US
Practice Address - Phone:808-242-6464
Practice Address - Fax:808-243-2343
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA208486OtherHMSA - HMSA QUEST - 65CP
HI99017685996793B102OtherTRICARE - CHAMPUS
HI07933103OtherALOHA CARE QUEST
HI463643OtherUHA
HI07933103Medicaid
HIS26070Medicare UPIN
HI99017685996793B102OtherTRICARE - CHAMPUS