Basic Information
Provider Information
NPI: 1659982726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARZ
FirstName: LEIF
MiddleName: ALEXANDER
NamePrefix: DR.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1641 NUUANU AVE APT 25
Address2:  
City: HONOLULU
State: HI
PostalCode: 968173238
CountryCode: US
TelephoneNumber: 8082953972
FaxNumber:  
Practice Location
Address1: 277 OHUA AVE
Address2:  
City: HONOLULU
State: HI
PostalCode: 968156612
CountryCode: US
TelephoneNumber: 8089224787
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/12/2020
LastUpdateDate: 08/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN-2997HIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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