Healthcare Provider Details

I. General information

NPI: 1083145684
Provider Name (Legal Business Name): SUSAN PALAZZO RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST SUITE 1406
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

615 PIIKOI ST SUITE 1406
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-397-3975
  • Fax:
Mailing address:
  • Phone: 808-397-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number9380652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: