Healthcare Provider Details

I. General information

NPI: 1811948045
Provider Name (Legal Business Name): ISLAND AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KAPIOLANI BLVD STE 950
HONOLULU HI
96814-4700
US

IV. Provider business mailing address

1601 KAPIOLANI BLVD STE 950
HONOLULU HI
96814-4700
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-4327
  • Fax: 808-589-2311
Mailing address:
  • Phone: 808-955-4327
  • Fax: 808-589-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD97
License Number StateHI

VIII. Authorized Official

Name: ROBIN C WIELINS
Title or Position: AUDIOLOGIST/OWNER
Credential: AU.D.
Phone: 808-955-4327