Provider Demographics
NPI:1962761940
Name:MARMEN, NICOLE JULIE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JULIE
Last Name:MARMEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3084
Mailing Address - Country:US
Mailing Address - Phone:808-935-3481
Mailing Address - Fax:808-935-4436
Practice Address - Street 1:460 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3084
Practice Address - Country:US
Practice Address - Phone:808-935-3481
Practice Address - Fax:808-935-4436
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI64267163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64267OtherHAWAII STATE BOARD OF NURSING