Provider Demographics
NPI:1699774240
Name:SOMERVILLE, PAULA DIANA/DIANNE (CRNP, APRN)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DIANA/DIANNE
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:CRNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 HIAHIA ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-9738
Mailing Address - Country:US
Mailing Address - Phone:724-556-9760
Mailing Address - Fax:
Practice Address - Street 1:1405 HIAHIA ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9738
Practice Address - Country:US
Practice Address - Phone:724-556-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000371A363LP2300X
HIAPRN-1443363LF0000X
HIRN-21059163W00000X
PARN182340L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004673Medicare ID - Type Unspecified
PAS47325Medicare UPIN