Healthcare Provider Details

I. General information

NPI: 1891622460
Provider Name (Legal Business Name): PATRICE NICOLE BLACKMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
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 StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: