Healthcare Provider Details

I. General information

NPI: 1609706118
Provider Name (Legal Business Name): NOVADERM CROWN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 HOBRON LN PH 1
HONOLULU HI
96815-1238
US

IV. Provider business mailing address

438 HOBRON LN PH 1
HONOLULU HI
96815-1238
US

V. Phone/Fax

Practice location:
  • Phone: 888-406-8099
  • Fax:
Mailing address:
  • Phone: 888-406-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PATRICE NICOLE BLACKMON
Title or Position: MANAGER
Credential:
Phone: 888-406-8099