Healthcare Provider Details

I. General information

NPI: 1508844861
Provider Name (Legal Business Name): ELTON EDWARD JOHNSON JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAND ISLAND PKWY USCG
HONOLULU HI
96819-4326
US

IV. Provider business mailing address

98-139 KANUKU ST APT 109
AIEA HI
96701-5123
US

V. Phone/Fax

Practice location:
  • Phone: 808-842-2930
  • Fax: 808-832-3281
Mailing address:
  • Phone: 808-488-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number583059
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number45098
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number69774
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number675
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: