Provider Demographics
NPI:1386964005
Name:MATHIS, VICTORIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:MATHIS
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 1:1564B WANAAO RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2633
Mailing Address - Country:US
Mailing Address - Phone:808-822-3829
Mailing Address - Fax:
Practice Address - Street 1:1564B WANAAO RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2633
Practice Address - Country:US
Practice Address - Phone:808-822-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 933363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology