Healthcare Provider Details

I. General information

NPI: 1346689106
Provider Name (Legal Business Name): KATHRYN ELIZABETH HENZLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE NAVAL HEALTH CLINIC HAWAII
JBPHH HI
96860-4908
US

IV. Provider business mailing address

1879 LAWRENCE RD
KAILUA HI
96734-4839
US

V. Phone/Fax

Practice location:
  • Phone: 808-257-3365
  • Fax:
Mailing address:
  • Phone: 252-412-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001219024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: