Healthcare Provider Details

I. General information

NPI: 1992232037
Provider Name (Legal Business Name): HAROLD NILSSON, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 825
HONOLULU HI
96814-4457
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD STE 825
HONOLULU HI
96814-4457
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-2772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD7520
License Number StateHI

VIII. Authorized Official

Name: HAROLD NILSSON
Title or Position: OWNER
Credential: MD
Phone: 808-941-2772