Healthcare Provider Details

I. General information

NPI: 1306670526
Provider Name (Legal Business Name): KIANI ELIZABETH WATKINS-DECKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL. #5002
KAILUA HI
96734
US

IV. Provider business mailing address

94-349 HOKUAHIAHI ST APT 316
MILILANI HI
96789-1918
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax:
Mailing address:
  • Phone: 808-754-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: