Healthcare Provider Details

I. General information

NPI: 1265771828
Provider Name (Legal Business Name): DONALD E NICOL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 HALEMAUMAU ST STE F
HONOLULU HI
96821-2150
US

IV. Provider business mailing address

549 HALEMAUMAU ST STE F
HONOLULU HI
96821-2150
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-2164
  • Fax: 808-377-9705
Mailing address:
  • Phone: 808-373-2164
  • Fax: 808-377-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number3657
License Number StateHI

VIII. Authorized Official

Name: MR. DONALD EDWARD NICOL
Title or Position: PRESIDENT
Credential: MD
Phone: 808-373-2164