Provider Demographics
NPI:1487945317
Name:DERRYBERRY, MARIA JOHNSTON (ANP-BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOHNSTON
Last Name:DERRYBERRY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1158 MAMALAHOA HWY SUITE 8A PMB 157
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8442
Mailing Address - Country:US
Mailing Address - Phone:808-740-5700
Mailing Address - Fax:808-442-0891
Practice Address - Street 1:65-1158 MAMALAHOA HWY STE 8A
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8442
Practice Address - Country:US
Practice Address - Phone:808-740-5700
Practice Address - Fax:808-442-0891
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8329363LA2200X
HIAPRN-1346363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health