1417460635 NPI number — GLENDA FAYE TALI PHD, RN, APRN

Table of content: GLENDA FAYE TALI PHD, RN, APRN (NPI 1417460635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417460635 NPI number — GLENDA FAYE TALI PHD, RN, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALI
Provider First Name:
GLENDA
Provider Middle Name:
FAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOBLE, MOORE, NORTON
Provider Other First Name:
GLENDA
Provider Other Middle Name:
FAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NONE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417460635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 S BERETANIA ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-744-2543
Provider Business Mailing Address Fax Number:
866-451-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 S BERETANIA ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-744-2543
Provider Business Practice Location Address Fax Number:
866-451-4608
Provider Enumeration Date:
11/09/2017

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: 363LW0102X , with the licence number:  1225 , 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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