Healthcare Provider Details

I. General information

NPI: 1841528288
Provider Name (Legal Business Name): PAULA WYATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 WAIALAE AVE
HONOLULU HI
96816-5321
US

IV. Provider business mailing address

4218 WAIALAE AVE
HONOLULU HI
96816-5321
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-0007
  • Fax: 808-735-0021
Mailing address:
  • Phone: 808-735-0007
  • Fax: 808-735-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 7208
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: