Healthcare Provider Details

I. General information

NPI: 1497842827
Provider Name (Legal Business Name): CLARA T KREBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/07/2023
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 KOLOA ROAD SUITE G202
KOLOA HI
96756-9675
US

IV. Provider business mailing address

PO BOX 1887
KOLOA HI
96756-1887
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-5805
  • Fax:
Mailing address:
  • Phone: 360-359-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60005651
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15806
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: