Healthcare Provider Details

I. General information

NPI: 1639082407
Provider Name (Legal Business Name): ISLAND MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MERCHANT ST STE 102
HONOLULU HI
96813-4434
US

IV. Provider business mailing address

119 MERCHANT ST STE 102
HONOLULU HI
96813-4434
US

V. Phone/Fax

Practice location:
  • Phone: 808-431-7333
  • Fax:
Mailing address:
  • Phone: 808-431-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA LYNNE BURNS
Title or Position: MEDICAL DIRECTOR
Credential: FNP-BC
Phone: 808-763-1048