1700921236 NPI number — MRS. HONEY ANN FRIEND CHARLES LSW

Table of content: MRS. HONEY ANN FRIEND CHARLES LSW (NPI 1700921236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700921236 NPI number — MRS. HONEY ANN FRIEND CHARLES LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARLES
Provider First Name:
HONEY
Provider Middle Name:
ANN FRIEND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIMELFENNING
Provider Other First Name:
HONEY
Provider Other Middle Name:
ANN FRIEND
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700921236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4370 KUKUI GROVE STREET
Provider Second Line Business Mailing Address:
SUITE 3-211
Provider Business Mailing Address City Name:
LIHUE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-274-3190
Provider Business Mailing Address Fax Number:
808-274-3194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4370 KUKUI GROVE STREET
Provider Second Line Business Practice Location Address:
SUITE 3-211
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-274-3190
Provider Business Practice Location Address Fax Number:
808-274-3194
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LSW 558 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53937201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".