Healthcare Provider Details

I. General information

NPI: 1811531338
Provider Name (Legal Business Name): ALOHA MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE LOWR LEVEL
HONOLULU HI
96817-5193
US

IV. Provider business mailing address

PO BOX 60599
EWA BEACH HI
96706-7599
US

V. Phone/Fax

Practice location:
  • Phone: 808-664-1104
  • Fax: 866-592-3149
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LORILYNN LAUPOLA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 808-664-1104