Healthcare Provider Details

I. General information

NPI: 1801220413
Provider Name (Legal Business Name): RENE MAHEALANI TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENE MAHEALANI SHEA

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 LIHOLIHO ST APT J
HONOLULU HI
96822-2901
US

IV. Provider business mailing address

1644 LIHOLIHO ST APT J
HONOLULU HI
96822-2901
US

V. Phone/Fax

Practice location:
  • Phone: 915-342-0200
  • Fax:
Mailing address:
  • Phone: 915-342-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number17638
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number219145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: