Healthcare Provider Details

I. General information

NPI: 1831186998
Provider Name (Legal Business Name): MARY PORTERFIELD JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PRINCETON PL
HONOLULU HI
96818-5044
US

IV. Provider business mailing address

4515 PRINCETON PL
HONOLULU HI
96818-5044
US

V. Phone/Fax

Practice location:
  • Phone: 808-455-5981
  • Fax:
Mailing address:
  • Phone: 808-455-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN-46072
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: