Provider Demographics
NPI:1154836328
Name:BASOC, LORRAINE DORMINTES (RN)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:DORMINTES
Last Name:BASOC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DEMENT ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4109
Mailing Address - Country:US
Mailing Address - Phone:808-745-8741
Mailing Address - Fax:
Practice Address - Street 1:1515 DEMENT ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4109
Practice Address - Country:US
Practice Address - Phone:808-745-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-87963163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health