Provider Demographics
NPI:1487737888
Name:MIZUO, MARI (APRN)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:MIZUO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S KING STREET
Mailing Address - Street 2:STE 309
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-589-1156
Mailing Address - Fax:808-589-1404
Practice Address - Street 1:1350 S KING ST
Practice Address - Street 2:SUITE 309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-589-1156
Practice Address - Fax:808-589-1404
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRNS1115163W00000X
HIAPRN837363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI581810Medicaid