Provider Demographics
NPI:1154925535
Name:BLUE, LAURA ALINE (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALINE
Last Name:BLUE
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 1:86-545 HAKALINA RD
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2803
Mailing Address - Country:US
Mailing Address - Phone:808-627-2333
Mailing Address - Fax:
Practice Address - Street 1:86-545 HAKALINA RD
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2803
Practice Address - Country:US
Practice Address - Phone:808-627-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI46278163WC0400X
HI3875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management