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Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1720599640

Individual Registrant:
Gender: F
Sole Proprietor

Location and contact information for practice:
15-1552 5TH AVENUE  KEAAU, HI 96749 US
Tel: 808-430-2627  Fax: --

Contact information for business:
PO BOX 2133  KEAAU, HI 96749-2133 US
Tel: 808-430-2627  Fax: --

Registration Information:
NPI: 1720599640
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Legacy codes, insurance codes and state license numbers:



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