Healthcare Provider Details

I. General information

NPI: 1174465298
Provider Name (Legal Business Name): MADELINE DIANE MCKINNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 KAMOKILA BLVD STE 355
KAPOLEI HI
96707-2035
US

IV. Provider business mailing address

719 12TH AVE
HONOLULU HI
96816-6453
US

V. Phone/Fax

Practice location:
  • Phone: 808-733-9357
  • Fax: 808-733-9357
Mailing address:
  • Phone: 360-558-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: