Healthcare Provider Details

I. General information

NPI: 1801213178
Provider Name (Legal Business Name): STACEY OKANO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-1397 OLE POHAKU 35TH PLACE
KEAAU HI
96749
US

IV. Provider business mailing address

PO BOX 7014
HILO HI
96720-8937
US

V. Phone/Fax

Practice location:
  • Phone: 808-982-7828
  • Fax: 808-982-7822
Mailing address:
  • Phone: 808-982-7828
  • Fax: 808-982-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number1525-C
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: