Healthcare Provider Details

I. General information

NPI: 1992781124
Provider Name (Legal Business Name): JULIANE DOUGLAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRIPLER ARMY MEDICAL CENTER 1 JARRETT WHITE ROAD
HONOLULU HI
96859
US

IV. Provider business mailing address

44-694 KAHINANI PL
KANEOHE HI
96744-2546
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-9333
  • Fax:
Mailing address:
  • Phone: 808-433-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAMD-521
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-521
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: