Healthcare Provider Details

I. General information

NPI: 1548620958
Provider Name (Legal Business Name): ADVANCED HEALING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1099 WAIEMI ST
EWA BEACH HI
96706-6413
US

IV. Provider business mailing address

91-1099 WAIEMI ST
EWA BEACH HI
96706-6413
US

V. Phone/Fax

Practice location:
  • Phone: 302-363-5839
  • Fax: 302-424-7755
Mailing address:
  • Phone: 302-363-5839
  • Fax: 302-424-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-754
License Number StateHI

VIII. Authorized Official

Name: WILLIAM MATTHEWS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 302-363-5839