Healthcare Provider Details

I. General information

NPI: 1316023740
Provider Name (Legal Business Name): CAROLYN M LESNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W KAWILI ST CAMPUS CENTER 212
HILO HI
96720-4075
US

IV. Provider business mailing address

200 W KAWILI ST CAMPUS CENTER 212
HILO HI
96720-4075
US

V. Phone/Fax

Practice location:
  • Phone: 808-974-7636
  • Fax: 808-933-0868
Mailing address:
  • Phone: 808-974-7636
  • Fax: 808-933-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number17627
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: