1073510202 NPI number — MS. LAURIANN MAHEALANI BROAD FNPC

Table of content: MS. LAURIANN MAHEALANI BROAD FNPC (NPI 1073510202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073510202 NPI number — MS. LAURIANN MAHEALANI BROAD FNPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROAD
Provider First Name:
LAURIANN
Provider Middle Name:
MAHEALANI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073510202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45-558 AWAPAPA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANEOHE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96744-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-8690
Provider Business Mailing Address Fax Number:
808-433-8694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRIPLER ARMY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
COMMUNITY HEALTH NURSING
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96759-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-6890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2005

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: 163WP2201X , with the licence number:  130 , 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)





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