Provider Demographics
NPI:1699650481
Name:FAWAZ, MARIAM NAOMI (APRN)
Entity type:Individual
Prefix:MS
First Name:MARIAM
Middle Name:NAOMI
Last Name:FAWAZ
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 1:91-1082 KAIMALIE ST APT 2K3
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5054
Mailing Address - Country:US
Mailing Address - Phone:865-441-1721
Mailing Address - Fax:
Practice Address - Street 1:91-1082 KAIMALIE ST APT 2K3
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5054
Practice Address - Country:US
Practice Address - Phone:865-441-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-5327363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health