Healthcare Provider Details

I. General information

NPI: 1275375073
Provider Name (Legal Business Name): CHARISSA BAKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

2290 AKEPA ST
PEARL CITY HI
96782-1022
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0256
  • Fax:
Mailing address:
  • Phone: 808-347-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number81123
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: