Healthcare Provider Details

I. General information

NPI: 1366371908
Provider Name (Legal Business Name): MAKALA ELISE GARDNER MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAKAYLA ELISE GARDNER MS, RD, LD

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1125 MAMALAHOA HWY
KAMUELA HI
96743-8496
US

IV. Provider business mailing address

PO BOX 1649
HONOKAA HI
96727-1649
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number525-LD
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: