Provider Demographics
NPI:1972332237
Name:DEWITT, NICOLE MICHELE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MICHELE
Other - Last Name:DUVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:683 WAIANAE AVE BLDG G
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:808-433-9278
Mailing Address - Fax:808-433-8154
Practice Address - Street 1:683 WAIANAE AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-433-9278
Practice Address - Fax:808-433-8154
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-71804163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management