Individual
IBID M NICOLAISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
81-980 HALEKII ST STE 107, KEALAKEKUA, HI 96750-8177
(808) 324-0703
Mailing address
75-5751 KUAKINI HWY STE 203, KAILUA KONA, HI 96740-1753
(808) 326-5629
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
A117690
IA
363LF0000X
Family Nurse Practitioner
Primary
APRN-2139
HI
Other
Enumeration date
07/05/2016
Last updated
02/25/2021
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