Healthcare Provider Details

I. General information

NPI: 1609774777
Provider Name (Legal Business Name): NANEA SOPHIA KARNUTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2026
Last Update Date: 10/28/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KALEPA PL
KAHULUI HI
96732-2471
US

IV. Provider business mailing address

200 KALEPA PL
KAHULUI HI
96732-2471
US

V. Phone/Fax

Practice location:
  • Phone: 808-871-7116
  • Fax:
Mailing address:
  • Phone: 808-871-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAMD-1603
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: