Provider Demographics
NPI:1245814383
Name:FODRAN, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:FODRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MILILANI ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2934
Mailing Address - Country:US
Mailing Address - Phone:808-550-2552
Mailing Address - Fax:808-551-2551
Practice Address - Street 1:820 MILILANI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2993
Practice Address - Country:US
Practice Address - Phone:808-550-2552
Practice Address - Fax:808-550-2551
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3502363LF0000X
CA95013279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily