Healthcare Provider Details

I. General information

NPI: 1942951264
Provider Name (Legal Business Name): ONYEWEENU CAROLYN OGENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 SALT LAKE BLVD STE C4
HONOLULU HI
96818-3171
US

IV. Provider business mailing address

1717 ALA WAI BLVD APT 304
HONOLULU HI
96815-1520
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-1804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: