Healthcare Provider Details

I. General information

NPI: 1023863305
Provider Name (Legal Business Name): ELIZABETH KAWANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

952 KAAHUE ST
HONOLULU HI
96825-1341
US

V. Phone/Fax

Practice location:
  • Phone: 800-214-1306
  • Fax:
Mailing address:
  • Phone: 808-699-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21420425
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN62390
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: