Provider Demographics
NPI:1962093716
Name:ONTIVERO, LISANDRA (BSN, RN)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:ONTIVERO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 KULEKIA ALY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4889
Mailing Address - Country:US
Mailing Address - Phone:813-562-7744
Mailing Address - Fax:
Practice Address - Street 1:3155 MANOA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1228
Practice Address - Country:US
Practice Address - Phone:808-988-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI97546163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool