1770750127 NPI number — ME LAVONNE FUIMAONO-POE APRN RX- NP C

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 1770750127 NPI number — ME LAVONNE FUIMAONO-POE APRN RX- NP C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUIMAONO-POE
Provider First Name:
ME
Provider Middle Name:
LAVONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN RX- NP C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUIMAONO
Provider Other First Name:
MAE
Provider Other Middle Name:
LAVONNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN-RX
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770750127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1132 BISHOP ST UNIT 1704
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:
96813-2893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-489-2925
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
677 ALA MOANA BLVD STE 903
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:
96813-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-308-0300
Provider Business Practice Location Address Fax Number:
833-471-5801
Provider Enumeration Date:
05/14/2008

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: 363LF0000X , with the licence number:  APRN 1753 , 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: 539372-18 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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