Healthcare Provider Details

I. General information

NPI: 1730736869
Provider Name (Legal Business Name): SUE KILP APRN-RX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-127 WAILOHIA PL
EWA BEACH HI
96706-1854
US

IV. Provider business mailing address

91-127 WAILOHIA PL
EWA BEACH HI
96706-1854
US

V. Phone/Fax

Practice location:
  • Phone: 808-927-4947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN-1945
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: