Healthcare Provider Details

I. General information

NPI: 1659613586
Provider Name (Legal Business Name): JOHN ALLAN STOWELL RN, CWCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE AVE
HILO HI
96720-2089
US

IV. Provider business mailing address

HC 1 BOX 5468
KEAAU HI
96749-9534
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3128
  • Fax:
Mailing address:
  • Phone: 808-982-9012
  • Fax: 808-982-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN-55878
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: