Healthcare Provider Details

I. General information

NPI: 1366771636
Provider Name (Legal Business Name): MERRIL ROGER GOODELL N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

888 S KING ST STRAUB DEPARTMENT OF GERIATRICS
HONOLULU HI
96813-3009
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-3159
  • Fax: 808-522-4345
Mailing address:
  • Phone: 808-522-3159
  • Fax: 808-522-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN-1231
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: