1770198921 NPI number — MRS. BESSIE MAE BETHANY STAR ERTEL

Table of content: MRS. BESSIE MAE BETHANY STAR ERTEL (NPI 1770198921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770198921 NPI number — MRS. BESSIE MAE BETHANY STAR ERTEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERTEL
Provider First Name:
BESSIE
Provider Middle Name:
MAE BETHANY STAR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWNEY
Provider Other First Name:
BESSIE
Provider Other Middle Name:
MAE BETHANY STAR
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770198921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3002 GLEN COVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-4771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-909-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 PIIKOI ST
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:
96814-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-591-6068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2020

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: 106S00000X , 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)





Copyright © 2007-2025 www.npivalidator.com