Healthcare Provider Details

I. General information

NPI: 1184342123
Provider Name (Legal Business Name): PAIGE SUMIDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE AVE
HILO HI
96720-2089
US

IV. Provider business mailing address

1553 LEILEHUA ST
HILO HI
96720-3342
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3000
  • Fax:
Mailing address:
  • Phone: 808-896-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3757-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: