Healthcare Provider Details

I. General information

NPI: 1700673449
Provider Name (Legal Business Name): HEIDI C ICARANGAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DILLINGHAM BLVD STE 317
HONOLULU HI
96817-4551
US

IV. Provider business mailing address

1001 DILLINGHAM BLVD STE 317
HONOLULU HI
96817-4551
US

V. Phone/Fax

Practice location:
  • Phone: 808-294-7465
  • Fax: 808-809-8585
Mailing address:
  • Phone: 808-221-8425
  • Fax: 808-809-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-58396
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: