Healthcare Provider Details

I. General information

NPI: 1225418759
Provider Name (Legal Business Name): MAILE IWALANI ALCOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAILE IWALANI WAIWAIOLE

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 OHUA AVE
HONOLULU HI
96815-6612
US

IV. Provider business mailing address

277 OHUA AVE
HONOLULU HI
96815-6612
US

V. Phone/Fax

Practice location:
  • Phone: 808-922-4787
  • Fax: 808-922-4950
Mailing address:
  • Phone: 808-922-4787
  • Fax: 808-922-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1906
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: