Healthcare Provider Details

I. General information

NPI: 1134473366
Provider Name (Legal Business Name): CARL T PITRE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 609
HONOLULU HI
96813-2431
US

IV. Provider business mailing address

1329 LUSITANA ST STE 609
HONOLULU HI
96813-2431
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-0100
  • Fax: 866-438-6310
Mailing address:
  • Phone: 808-521-0100
  • Fax: 866-438-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1515
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: