Healthcare Provider Details

I. General information

NPI: 1073510202
Provider Name (Legal Business Name): LAURIANN MAHEALANI BROAD FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRIPLER ARMY MEDICAL CENTER COMMUNITY HEALTH NURSING
HONOLULU HI
96759-5000
US

IV. Provider business mailing address

45-558 AWAPAPA PL
KANEOHE HI
96744-1923
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6890
  • Fax:
Mailing address:
  • Phone: 808-433-8690
  • Fax: 808-433-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number130
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: