Provider Demographics
NPI:1578235578
Name:DEBERNARDO, DIANA JEAN
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JEAN
Last Name:DEBERNARDO
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 1:307 PROSPECT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1802
Mailing Address - Country:US
Mailing Address - Phone:203-922-2898
Mailing Address - Fax:
Practice Address - Street 1:860 IWILEI RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5018
Practice Address - Country:US
Practice Address - Phone:808-924-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.010066363L00000X
HIAPRN-4363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner