Healthcare Provider Details

I. General information

NPI: 1801387675
Provider Name (Legal Business Name): JULIANNA NIKULLA VAN POELE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANNA MARIE BROWNE REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE STE 600
HONOLULU HI
96814-1611
US

IV. Provider business mailing address

91-1009 KAIAPO ST
EWA BEACH HI
96706-6220
US

V. Phone/Fax

Practice location:
  • Phone: 808-535-0974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-86393
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: