Healthcare Provider Details

I. General information

NPI: 1497325161
Provider Name (Legal Business Name): FUSION MEDICINE & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-3858 AKONI PULE HWY
KAPA'AU HI
96755-9675
US

IV. Provider business mailing address

PO BOX 811
KAPAAU HI
96755-0811
US

V. Phone/Fax

Practice location:
  • Phone: 808-726-2461
  • Fax:
Mailing address:
  • Phone: 808-726-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLOTTE CHARFEN
Title or Position: CEO
Credential: MD
Phone: 808-726-2461