Healthcare Provider Details

I. General information

NPI: 1891130761
Provider Name (Legal Business Name): IAN DALTON TAYLOR MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE 300
KAILUA HI
96734-4439
US

IV. Provider business mailing address

353 MALUNIU AVE
KAILUA HI
96734-2370
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4476
  • Fax: 808-263-4476
Mailing address:
  • Phone: 808-286-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 1567
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: