Healthcare Provider Details

I. General information

NPI: 1336870682
Provider Name (Legal Business Name): MAHELANI R OLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1841 FORT WEAVER RD
EWA BEACH HI
96706-1909
US

IV. Provider business mailing address

91-1451 KEAHUMOA PKWY UNIT 2705
EWA BEACH HI
96706-5880
US

V. Phone/Fax

Practice location:
  • Phone: 808-681-1419
  • Fax:
Mailing address:
  • Phone: 808-597-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: