Healthcare Provider Details

I. General information

NPI: 1962250209
Provider Name (Legal Business Name): DANIELLE N PUALAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1005
PAGO PAGO AS
96799-1005
US

IV. Provider business mailing address

459 PATTERSON RD (CSP)
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-566-8384
  • Fax:
Mailing address:
  • Phone: 808-566-8384
  • Fax: 808-566-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1264A
License Number StateAS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: