Healthcare Provider Details

I. General information

NPI: 1740114602
Provider Name (Legal Business Name): XAVIER R DURNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
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

91-1043 AUKAHI ST
KAPOLEI HI
96707-1997
US

V. Phone/Fax

Practice location:
  • Phone: 808-681-1419
  • Fax: 808-681-1486
Mailing address:
  • Phone: 808-681-1419
  • Fax: 808-681-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number172V00000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: