Healthcare Provider Details

I. General information

NPI: 1104123736
Provider Name (Legal Business Name): SALEE JANE OBOZA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-474-4242
  • Fax:
Mailing address:
  • Phone: 808-474-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041303856
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: