Healthcare Provider Details

I. General information

NPI: 1184119554
Provider Name (Legal Business Name): ELIZABETH KEHAU KEALOHA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-778 PAELIALANUI STREET
KAMUELA HI
96743
US

IV. Provider business mailing address

PO BOX 2625
KAMUELA HI
96743-2625
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6659
  • Fax:
Mailing address:
  • Phone: 808-557-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-22039
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: