Healthcare Provider Details

I. General information

NPI: 1609522416
Provider Name (Legal Business Name): KYLIE M NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 COLBURN ST
HONOLULU HI
96819-3248
US

IV. Provider business mailing address

1022 PROSPECT ST APT 1202
HONOLULU HI
96822-3450
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-0102
  • Fax:
Mailing address:
  • Phone: 503-504-0162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-205496
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: