Healthcare Provider Details

I. General information

NPI: 1679210470
Provider Name (Legal Business Name): JARYN IWAMOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JARYN LAU

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD
AIEA HI
96701-4713
US

IV. Provider business mailing address

98-673 KEIKIALII ST
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-5414
  • Fax: 808-485-3022
Mailing address:
  • Phone: 808-222-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberAPRN-3345
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: