Healthcare Provider Details

I. General information

NPI: 1932015831
Provider Name (Legal Business Name): PRITIKA VANDANA PURCELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-484 IOSEPA ST
LAIE HI
96762-1105
US

IV. Provider business mailing address

55-484 IOSEPA ST
LAIE HI
96762-1105
US

V. Phone/Fax

Practice location:
  • Phone: 808-364-0893
  • Fax:
Mailing address:
  • Phone: 808-364-0893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: