Provider Demographics
NPI:1598008849
Name:DENNIS, VICTORIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KAMEHAMEHA V HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748
Mailing Address - Country:US
Mailing Address - Phone:808-553-9080
Mailing Address - Fax:808-553-3353
Practice Address - Street 1:691 MOPUA ST
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5629
Practice Address - Country:US
Practice Address - Phone:808-553-9080
Practice Address - Fax:808-553-3353
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1250363LF0000X
WA2009008937363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1250OtherAPRN 1250
HI361OtherAPRN PRESCRIPTIVE AUTHORITY
HIRN00150OtherDEPARTMENT OF PUBLIC SAFETY, NARCOTIC ENFORCEMENT DIVISION