Healthcare Provider Details

I. General information

NPI: 1255812830
Provider Name (Legal Business Name): CHRISTINE LEE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 LILIHA ST STE B2
HONOLULU HI
96817-1605
US

IV. Provider business mailing address

1296 KAPIOLANI BLVD APT 1201
HONOLULU HI
96814-2880
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-6881
  • Fax:
Mailing address:
  • Phone: 808-729-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2503
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: