Healthcare Provider Details

I. General information

NPI: 1205286846
Provider Name (Legal Business Name): MICHELLE PHELPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

IV. Provider business mailing address

6938 KALANIANAOLE HWY
HONOLULU HI
96825-2010
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-0000
  • Fax:
Mailing address:
  • Phone: 614-638-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN-81836
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: