Healthcare Provider Details

I. General information

NPI: 1831053412
Provider Name (Legal Business Name): AMY WHARTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PUUHONU PL STE 100
HILO HI
96720-2060
US

IV. Provider business mailing address

73 PUUHONU PL STE 100
HILO HI
96720-2060
US

V. Phone/Fax

Practice location:
  • Phone: 808-687-0117
  • Fax: 808-687-0117
Mailing address:
  • Phone: 808-687-0117
  • Fax: 808-687-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: