Healthcare Provider Details

I. General information

NPI: 1013791623
Provider Name (Legal Business Name): MADE R ALDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 209
KAILUA HI
96734-4439
US

IV. Provider business mailing address

642 ULUKAHIKI ST STE 209
KAILUA HI
96734-4439
US

V. Phone/Fax

Practice location:
  • Phone: 808-230-8500
  • Fax: 808-230-8501
Mailing address:
  • Phone: 808-230-8500
  • Fax: 808-230-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08230808
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: