Healthcare Provider Details

I. General information

NPI: 1588203400
Provider Name (Legal Business Name): CHRISTINA MARIE NARAYANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

IV. Provider business mailing address

2107 SIMPSON ST
HONOLULU HI
96819-2102
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-1880
  • Fax:
Mailing address:
  • Phone: 361-442-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number718970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: