Healthcare Provider Details

I. General information

NPI: 1659762052
Provider Name (Legal Business Name): ERIN COUGHLIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE STREET SUITE #405 KAILUA PROFESSIONAL CENTER 1
KAILUA HI
96734
US

IV. Provider business mailing address

30 AULIKE STREET SUITE #405 KAILUA PROFESSIONAL CENTER 1
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-7340
  • Fax: 808-263-7339
Mailing address:
  • Phone: 808-263-7340
  • Fax: 808-263-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1805
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: