Healthcare Provider Details

I. General information

NPI: 1053619239
Provider Name (Legal Business Name): KRISTIN VIRGINIA DAVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN VIRGINIA LANGEN RN

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE ATTN MEDICAL STAFF SERVICES PROF- RM218
J B P H H HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE ATTN MEDICAL STAFF SERVICES PROF- RM218
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-471-1866
  • Fax: 808-471-0918
Mailing address:
  • Phone: 808-471-1866
  • Fax: 808-471-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number543277
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN-68819
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: