Healthcare Provider Details

I. General information

NPI: 1528049814
Provider Name (Legal Business Name): QUEENS NORTH HAWAII COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1125 MAMALAHOA HWY
KAMUELA HI
96743-8496
US

IV. Provider business mailing address

67-1125 MAMALAHOA HWY
KAMUELA HI
96743-8496
US

V. Phone/Fax

Practice location:
  • Phone: 808-881-4400
  • Fax: 808-881-4404
Mailing address:
  • Phone: 808-881-4400
  • Fax: 808-881-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-272
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number39H
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39H
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39H
License Number StateHI
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number39H
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39H
License Number StateHI
# 7
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-424
License Number StateHI
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-1488
License Number StateHI
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1477
License Number StateHI
# 11
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number39H
License Number StateHI
# 12
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number39H
License Number StateHI

VIII. Authorized Official

Name: MONEY S. ATWAL
Title or Position: DIRECTOR OF FINANCE & IT
Credential:
Phone: 808-881-4409