Healthcare Provider Details

I. General information

NPI: 1174998553
Provider Name (Legal Business Name): MS. ANNA SMIRNOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 MOLEHULEHU ST
KAHULUI HI
96732-4520
US

IV. Provider business mailing address

957 AALAPAPA DR
KAILUA HI
96734-3117
US

V. Phone/Fax

Practice location:
  • Phone: 828-620-8525
  • Fax:
Mailing address:
  • Phone: 828-620-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number109910
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95055481
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9479016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: