1417391814 NPI number — EAST HAWAII MIDWIFE SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417391814 NPI number — EAST HAWAII MIDWIFE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST HAWAII MIDWIFE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417391814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13-3553 LUANA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAHOA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96778-8417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-936-4068
Provider Business Mailing Address Fax Number:
808-935-9768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13-3591 LUANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-936-4068
Provider Business Practice Location Address Fax Number:
808-965-9768
Provider Enumeration Date:
04/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESTES
Authorized Official First Name:
ROXANNE
Authorized Official Middle Name:
CAROLYN
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
808-936-4068

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X , with the licence number:  APRN 1123 , 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)