Healthcare Provider Details

I. General information

NPI: 1083959621
Provider Name (Legal Business Name): ALICE DEUTSCH MENDYKOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE DEUTSCH

II. Dates (important events)

Enumeration Date: 12/08/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST STE 300
KAILUA HI
96734-2751
US

IV. Provider business mailing address

46-078 EMEPELA PL APT J201
KANEOHE HI
96744-3960
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5015
  • Fax: 808-263-5015
Mailing address:
  • Phone: 805-404-4859
  • Fax: 808-263-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1522
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1522
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: